Healthcare Provider Details

I. General information

NPI: 1548220882
Provider Name (Legal Business Name): WESTERN ROCKINGHAM FAMILY MEDICINE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W DECATUR ST
MADISON NC
27025-1913
US

IV. Provider business mailing address

401 W DECATUR ST
MADISON NC
27025-1913
US

V. Phone/Fax

Practice location:
  • Phone: 336-548-9618
  • Fax: 336-548-4877
Mailing address:
  • Phone: 336-548-9618
  • Fax: 336-548-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number17591
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DONALD WILSON MOORE
Title or Position: OWNER
Credential: MD
Phone: 336-548-9618