Healthcare Provider Details

I. General information

NPI: 1629046479
Provider Name (Legal Business Name): ENT & AUDIOLOGY ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 ED DR
RALEIGH NC
27612-8037
US

IV. Provider business mailing address

3820 ED DR
RALEIGH NC
27612-8037
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-9003
  • Fax: 919-782-9303
Mailing address:
  • Phone: 919-782-9003
  • Fax: 919-782-9303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS K HOLMES
Title or Position: CO OWNER
Credential: MD
Phone: 919-782-9003