Healthcare Provider Details

I. General information

NPI: 1710492871
Provider Name (Legal Business Name): CARTERET SURGICAL ASSOCIATES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 COUNTRY CLUB RD STE 800
JACKSONVILLE NC
28546-2400
US

IV. Provider business mailing address

3714 GUARDIAN AVE STE E
MOREHEAD CITY NC
28557-2975
US

V. Phone/Fax

Practice location:
  • Phone: 910-939-5759
  • Fax:
Mailing address:
  • Phone: 252-222-5862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT JACOB WATSON
Title or Position: CREDENTIALIST
Credential:
Phone: 252-222-5862