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Organization
RALEIGH FAMILY PRACTICE PA
Active
Organization
RALEIGH FAMILY PRACTICE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIN T FISHER (PRACTICE ADMINISTRATOR)
(919) 875-0539
Entity
Organization
Contact information
Practice address
4414 LAKE BOONE TRL, SUITE 502, RALEIGH, NC 27607-7513
(919) 875-0539
(919) 875-1051
Mailing address
4414 LAKE BOONE TRL, SUITE 502, RALEIGH, NC 27607-7513
(919) 875-0539
(919) 875-1051
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
84061
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7901842
—
NC
Enumeration date
12/06/2006
Last updated
08/22/2020
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