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General NPI Number Information
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NPI Number | 1083673511
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Entity Type | Organization
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Legal Business Name | DARE MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 604 AMANDA ST
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City | MANTEO
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State | NC
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Zip | 27954
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Country | US
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Telephone | 252-473-3478
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Fax | 252-473-3600
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Provider Business Mailing Address
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Address Line | PO BOX 1045
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City | MANTEO
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State | NC
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Zip | 27954-1045
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Country | US
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Telephone | 252-473-3478
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Fax | 252-473-3600
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Authorized Official
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Title or Position | OWNER
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Name | WALTER L HOLTON
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Credential | MD
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Telephone | 252-473-3478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 19609
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License Number State | NC
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