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Organization
ADVANCE FAMILY AND SPORTS MEDICINE CENTER, PLLC
Active
Organization
ADVANCE FAMILY AND SPORTS MEDICINE CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER EZEIGBO MD (OWNER/CEO)
(336) 940-2659
Entity
Organization
Contact information
Practice address
169 YADKIN VALLEY RD, SUITE 101, ADVANCE, NC 27006-8786
(336) 940-2659
Mailing address
169 YADKIN VALLEY RD, SUITE 101, ADVANCE, NC 27006-8786
(336) 940-2659
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
NULL
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
Other
Enumeration date
06/28/2010
Last updated
11/05/2010
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