Healthcare Provider Details

I. General information

NPI: 1316930787
Provider Name (Legal Business Name): ROY N EVERETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NEUSE BLVD
NEW BERN NC
28560-3449
US

IV. Provider business mailing address

PO BOX 896206
CHARLOTTE NC
28289-6206
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-8111
  • Fax:
Mailing address:
  • Phone: 252-633-8111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number27790
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: