Healthcare Provider Details

I. General information

NPI: 1013970136
Provider Name (Legal Business Name): ROCKY MOUNT UROLOGY ASSOC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FOY DR
ROCKY MOUNT NC
27804-2417
US

IV. Provider business mailing address

180 FOY DR
ROCKY MOUNT NC
27804-2417
US

V. Phone/Fax

Practice location:
  • Phone: 252-443-3136
  • Fax: 252-443-3847
Mailing address:
  • Phone: 252-443-3136
  • Fax: 252-443-3847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARON CREECH MURRAY
Title or Position: OFFICE MANAGER
Credential:
Phone: 252-443-3136