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General NPI Number Information
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NPI Number | 1255514592
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Entity Type | Organization
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Legal Business Name | RALEIGH DURHAM MEDICAL GROUP, PA
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 1 SAINT DUNSTANS RD
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City | ASHEVILLE
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State | NC
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Zip | 28803-2790
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Country | US
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Telephone | 828-252-4020
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Fax | 828-252-4022
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Provider Business Mailing Address
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Address Line | 5420 WADE PARK BLVD STE. 106
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City | RALEIGH
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State | NC
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Zip | 27607-4188
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Country | US
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Telephone | 919-233-5952
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Fax | 919-854-7774
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | DAVID K. MOYE
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Credential |
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Telephone | 919-851-2174
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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 |
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License Number State |
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