=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760586150
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAFAEL E NEGRON-MEDINA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2006
-----------------------------------------------------
Last Update Date | 06/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 103 PROFESSIONAL PARK STE C
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27565-2581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-690-3020
-----------------------------------------------------
Fax | 919-690-0525
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1554
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27565-1554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-690-3020
-----------------------------------------------------
Fax | 919-690-0525
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 200800411
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------