Healthcare Provider Details

I. General information

NPI: 1265757157
Provider Name (Legal Business Name): SURRY PARKER ROBERTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WOODBURN RD
RALEIGH NC
27605-1617
US

IV. Provider business mailing address

120 WOODBURN RD
RALEIGH NC
27605-1617
US

V. Phone/Fax

Practice location:
  • Phone: 919-828-2245
  • Fax: 919-836-1965
Mailing address:
  • Phone: 919-828-2245
  • Fax: 919-836-1965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberNC-00-15169
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: