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General NPI Number Information
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NPI Number | 1942524129
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Entity Type | Organization
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Legal Business Name | PROGRESS WEIGHT LOSS, PC
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Dates
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Enumeration Date | 03/17/2010
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 4207 LAKE BOONE TRL
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City | RALEIGH
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State | NC
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Zip | 27607-6684
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Country | US
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Telephone | 919-780-0815
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Fax | 919-781-0816
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Provider Business Mailing Address
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Address Line | 2801 BLUE RIDGE RD SUITE 101
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City | RALEIGH
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State | NC
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Zip | 27607-6474
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Country | US
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Telephone | 919-781-0185
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Fax | 919-780-0816
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH MORAN
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Credential | MD
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Telephone | 919-781-0815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 200400388
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License Number State | NC
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