Healthcare Provider Details

I. General information

NPI: 1578561734
Provider Name (Legal Business Name): KENT A VANBELOIS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4286 RAEFORD RD
FAYETTEVILLE NC
28304-3247
US

IV. Provider business mailing address

4286 RAEFORD RD
FAYETTEVILLE NC
28304-3247
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-8304
  • Fax: 910-483-3478
Mailing address:
  • Phone: 910-483-8304
  • Fax: 910-483-3478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number92
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: