Basic Information
| Provider Information | |||||||||
| NPI: | 1225191166 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | INMAN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 PROVIDENCE RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047495800 | ||||||||
| FaxNumber: | 7047495819 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 PROVIDENCE RD | ||||||||
| Address2: | STE 101 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047495800 | ||||||||
| FaxNumber: | 7047495819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2006 | ||||||||
| LastUpdateDate: | 03/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD23646 | ME | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 0101239795 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 042.0011562 | VT | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 2010-00290 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | NC1929 | 01 | NC | SC MEDICAID | OTHER | 1809A | 01 | NC | BCBS NC | OTHER |