Healthcare Provider Details

I. General information

NPI: 1689782989
Provider Name (Legal Business Name): GRETA F O'BUCH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 N FAYETTEVILLE ST STE A
ASHEBORO NC
27203-5573
US

IV. Provider business mailing address

218 FOUST ST STE C
ASHEBORO NC
27203-5476
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-3248
  • Fax: 336-625-6573
Mailing address:
  • Phone: 336-625-2333
  • Fax: 336-625-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103764
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number103764
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: