Healthcare Provider Details

I. General information

NPI: 1457585382
Provider Name (Legal Business Name): JAIME PEDRAZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7750 MCCRIMMON PKWY STE 100
CARY NC
27519-1912
US

IV. Provider business mailing address

7750 MCCRIMMON PKWY STE 100
CARY NC
27519-1912
US

V. Phone/Fax

Practice location:
  • Phone: 919-234-1577
  • Fax: 888-355-8929
Mailing address:
  • Phone: 919-234-1577
  • Fax: 888-355-8929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2013-01532
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number201301532
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: