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General NPI Number Information
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NPI Number | 1235562067
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Entity Type | Organization
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Legal Business Name | WAKE EMERGENCY PHYSICIANS PA
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Dates
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Enumeration Date | 08/15/2013
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 400 US 70 HWY E
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City | GARNER
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State | NC
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Zip | 27529
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Country | US
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Telephone | 919-350-8000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 890053
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City | CHARLOTTE
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State | NC
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Zip | 28289-0053
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Country | US
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Telephone | 800-815-7491
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Fax | 843-237-9736
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JENNIFER RALEY
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Credential | MD
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Telephone | 919-859-3373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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