Healthcare Provider Details

I. General information

NPI: 1962404384
Provider Name (Legal Business Name): REGIONAL DIABETES AND ENDOCRINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ROBESON ST STE 405
FAYETTEVILLE NC
28301-5520
US

IV. Provider business mailing address

PO BOX 40908
FAYETTEVILLE NC
28309-0908
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-1623
  • Fax: 910-321-6248
Mailing address:
  • Phone: 910-615-6448
  • Fax: 910-615-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH BARTON FISER
Title or Position: VP CORPORATE REVEUNE CYCLE
Credential:
Phone: 910-615-5572