Healthcare Provider Details

I. General information

NPI: 1407045628
Provider Name (Legal Business Name): THE YROGERG MEDICAL GROUP, P.L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E. LIVERMORE DRIVE SUITE #1 ANGEL EXCHANGE
PEMBROKE NC
28372
US

IV. Provider business mailing address

201 E. LIVERMORE DRIVE SUITE #1 ANGEL EXCHANGE
PEMBROKE NC
28372
US

V. Phone/Fax

Practice location:
  • Phone: 910-522-7185
  • Fax: 910-522-7184
Mailing address:
  • Phone: 910-522-7185
  • Fax: 910-522-7184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number145009
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103971
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number145009
License Number StateNC

VIII. Authorized Official

Name: GREGORY E. SMITH
Title or Position: PHYSICIAN ASSISTANT / ADMINISTRATIV
Credential: P.A.
Phone: 910-522-7185