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Organization
ROXBORO FAMILY MEDICINE & IMMEDIATE
Active
Organization
ROXBORO FAMILY MEDICINE & IMMEDIATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA P SHOCK PA (PRESIDENT)
(336) 598-5480
Entity
Organization
Contact information
Practice address
228 S MADISON BLVD, ROXBORO, NC 27573-5428
(336) 598-5480
(336) 598-5482
Mailing address
PO BOX 61474, DURHAM, NC 27715-1474
(919) 544-6318
(919) 544-6336
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014M1
BCBS-NC GROUP NO
NC
05
—
5903189
—
NC
Enumeration date
07/05/2006
Last updated
06/10/2009
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