Healthcare Provider Details

I. General information

NPI: 1457365751
Provider Name (Legal Business Name): FAYETTEVILLE GASTROENTEROLOGY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 04/14/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 VALLEYGATE DR
FAYETTEVILLE NC
28304-3688
US

IV. Provider business mailing address

2041 VALLEYGATE DR
FAYETTEVILLE NC
28304-3688
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-5203
  • Fax: 910-323-3650
Mailing address:
  • Phone: 910-323-5203
  • Fax: 910-323-3650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAS0071
License Number StateNC

VIII. Authorized Official

Name: DR. WILLIAM F VORDER BRUEGGE
Title or Position: OWNER
Credential: MD
Phone: 910-323-5203