John K Southard Jr., M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

18576 Issued in NC

Practice address

1345B Westgate Center Dr
Winston-Salem, NC 27103-2934

Phone

(336) 768-1280

Fax

(336) 760-8443

NPI assigned

Oct 5, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Dr. John K. Southard Jr. Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: southard.john.002.0330038@wede.meditab.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Westgate Dermatology and Laser Center, P.a.

  • Dermatopathology Physician
  • Winston Salem, NC
  • NPI 1821240995
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239148800000",
    "number": "1649267535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1345B WESTGATE CENTER DR",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271032934",
            "telephone_number": "336-768-1280",
            "fax_number": "336-760-8443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1345B WESTGATE CENTER DR",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271032934",
            "telephone_number": "336-768-1280",
            "fax_number": "336-760-8443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHARD",
        "first_name": "JOHN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2009-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "18576",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NC",
            "license": "18576",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89013U8",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q18576",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHN",
            "last_name": "SOUTHARD",
            "middle_name": "K.",
            "prefix": "DR.",
            "suffix": "JR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Mary O Sotile, MA, LPC
• Wayne M Sotile, PH.D.
• Elizabeth Joan Soto, PA
• Candice Rae Sotriffer, M.A. ED.S LPC
• South Park Family Pharmacy LLC (South Park Family Pharmacy)
• Monica Espinoza Southard, MA BCBA
• Southerland Treatment and Rehab(Star) Counseling&Consulting SVCS, PLLC
• Timeka A Southerland, LPC
• Southern Assisted Living, LLC. (Brookdale Reynolda Road)
• Southern Home Care Services, Inc.

• Specialist in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.