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General NPI Number Information
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NPI Number | 1972803617
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Entity Type | Organization
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Legal Business Name | CAPE FEAR FAMILY MEDICAL CARE
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 405 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3411
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Country | US
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Telephone | 910-323-3183
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Fax |
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Provider Business Mailing Address
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Address Line | 405 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3411
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Country | US
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Telephone | 910-323-3183
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | BEVERLY A DE PONCEAU
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Credential |
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Telephone | 910-323-3183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5004935
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License Number State | NC
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