Healthcare Provider Details

I. General information

NPI: 1184794166
Provider Name (Legal Business Name): DAVID ALAN KATZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11130 CAPITAL BLVD
WAKE FOREST NC
27587-4513
US

IV. Provider business mailing address

260 HORIZON DR
RALEIGH NC
27615-4922
US

V. Phone/Fax

Practice location:
  • Phone: 919-488-4094
  • Fax: 919-488-4096
Mailing address:
  • Phone: 919-488-0015
  • Fax: 919-277-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34-003238
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number201100374
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: