Individual
DR. EDWIN L FUENTES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2509 RICHARDSON DR STE A, REIDSVILLE, NC 27320-5926
(336) 552-4274
Mailing address
109 DEER RUN RD, DANVILLE, VA 24540-2863
(434) 791-0306
(434) 791-0310
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102050134
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005641870
—
VA
01
—
9701749
STATE LICENSE NORTH CAROLINA
NC
Enumeration date
05/08/2006
Last updated
07/25/2023
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