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General NPI Number Information
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NPI Number | 1629185905
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Entity Type | Organization
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Legal Business Name | BRUNSWICK OB-GYN, P.A.
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 116 DURHAM ST STE 205
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City | SUPPLY
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State | NC
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Zip | 28462-1909
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Country | US
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Telephone | 910-755-5261
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 679
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City | SUPPLY
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State | NC
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Zip | 28462-0679
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Country | US
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Telephone | 910-755-5261
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Fax | 910-755-5263
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Authorized Official
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Title or Position | PRESIDENT
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Name | OWEN REGAN
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Credential | MD
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Telephone | 910-520-6730
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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 |
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License Number State | NC
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