Healthcare Provider Details

I. General information

NPI: 1427016138
Provider Name (Legal Business Name): ROXBORO INTERNAL MEDICINE & PEDIATRICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

796 DOCTORS CT
ROXBORO NC
27573-4571
US

IV. Provider business mailing address

796 DOCTORS CT
ROXBORO NC
27573-4571
US

V. Phone/Fax

Practice location:
  • Phone: 336-598-0002
  • Fax: 336-599-2159
Mailing address:
  • Phone: 336-598-0002
  • Fax: 336-599-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34464
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34464
License Number StateNC

VIII. Authorized Official

Name: MS. JENNIFER CLAYTON BOLTON
Title or Position: INSURANCE MANAGER
Credential:
Phone: 336-598-0002