Healthcare Provider Details

I. General information

NPI: 1467495903
Provider Name (Legal Business Name): ROBERT A FLEURY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 OLMSTED BLVD SUITE 1
PINEHURST NC
28374-9023
US

IV. Provider business mailing address

PO BOX 1630
PINEHURST NC
28370-1630
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-6007
  • Fax: 910-215-0179
Mailing address:
  • Phone: 910-295-6007
  • Fax: 910-215-0179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25998
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8932672
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: