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General NPI Number Information
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NPI Number | 1114942117
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Entity Type | Individual
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Provider Name | ROBERT MABRY DACUS IV M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 08/10/2025
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Provider Practice Location Address
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Address Line | 4420 LAKE BOONE TRL
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City | RALEIGH
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State | NC
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Zip | 27607-7505
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Country | US
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Telephone | 919-567-6133
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Fax |
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Provider Business Mailing Address
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Address Line | 781 AVENT FERRY RD STE 106
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-7776
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Country | US
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Telephone | 919-567-6133
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Fax | 919-567-6134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 9500289
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License Number State | NC
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