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General NPI Number Information
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NPI Number | 1407045628
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Entity Type | Organization
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Legal Business Name | THE YROGERG MEDICAL GROUP, P.L.L.C
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 201 E. LIVERMORE DRIVE SUITE #1 ANGEL EXCHANGE
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City | PEMBROKE
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State | NC
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Zip | 28372
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Country | US
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Telephone | 910-522-7185
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Fax | 910-522-7184
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Provider Business Mailing Address
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Address Line | 201 E. LIVERMORE DRIVE SUITE #1 ANGEL EXCHANGE
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City | PEMBROKE
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State | NC
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Zip | 28372
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Country | US
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Telephone | 910-522-7185
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Fax | 910-522-7184
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT / ADMINISTRATIV
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Name | GREGORY E. SMITH
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Credential | P.A.
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Telephone | 910-522-7185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 145009
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 103971
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 145009
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License Number State | NC
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