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General NPI Number Information
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NPI Number | 1922675172
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Entity Type | Organization
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Legal Business Name | PRIMARY BODY WORKS, PLLC
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Dates
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Enumeration Date | 06/07/2021
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 160 MACGREGOR PINES DR STE 101B
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City | CARY
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State | NC
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Zip | 27511-6037
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Country | US
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Telephone | 919-342-8585
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Fax | 877-808-6177
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Provider Business Mailing Address
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Address Line | 160 MACGREGOR PINES DR STE 101B
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City | CARY
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State | NC
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Zip | 27511-6037
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Country | US
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Telephone | 919-342-8585
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Fax | 877-808-6177
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Authorized Official
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Title or Position | CEO
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Name | JON MICHAEL BRUCE
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Credential | MD
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Telephone | 919-342-8585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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