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General NPI Number Information
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NPI Number | 1770544918
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Entity Type | Individual
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Provider Name | REGINALD DALE VILLEPONTEAUX MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3333 SILAS CREEK PKWY ATTN: IPOF
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City | WINSTON-SALEM
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State | NC
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Zip | 27103-3013
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Country | US
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Telephone | 336-718-7080
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 FRONTIS PLAZA BLVD STE 200 ATTN FORSYTH MEDICAL GROUP
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City | WINSTON SALEM
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State | NC
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Zip | 27103-5616
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Country | US
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Telephone | 336-277-2436
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 30506
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License Number State | NC
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