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General NPI Number Information
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NPI Number | 1861670929
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Entity Type | Organization
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Legal Business Name | CAPE FEAR SPORTS MEDICINE PA
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 10/06/2014
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Provider Practice Location Address
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Address Line | 6019 OLEANDER DRIVE SUITE 200
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City | WILMINGTON
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State | NC
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Zip | 28403
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Country | US
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Telephone | 910-790-9714
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Fax | 910-791-1063
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Provider Business Mailing Address
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Address Line | 6019 OLEANDER DRIVE SUITE 200
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City | WILMINGTON
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State | NC
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Zip | 28403
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Country | US
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Telephone | 910-790-9714
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Fax | 910-791-1063
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Authorized Official
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Title or Position | PRESIDENT
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Name | DALE BOYD JR.
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Credential | MD
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Telephone | 910-790-9714
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 35845
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License Number State | NC
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