Healthcare Provider Details

I. General information

NPI: 1669592804
Provider Name (Legal Business Name): GENE SHIRLEY ROF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 OWEN DR STE 102
FAYETTEVILLE NC
28304-3455
US

IV. Provider business mailing address

1840 OWEN DR STE 102
FAYETTEVILLE NC
28304-3455
US

V. Phone/Fax

Practice location:
  • Phone: 910-484-2645
  • Fax: 910-484-0866
Mailing address:
  • Phone: 910-484-2645
  • Fax: 910-484-0866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: