Organization
CAPE FEAR ORTHOPAEDIC CLINIC, PA
Active
Parent organization
CAPE FEAR ORTHOPAEDIC CLINIC, P.A.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CAPE FEAR ORTHOPAEDIC CLINIC, P.A.
Authorized official
MR. BRADLEY J BROUSSARD MD (PRESIDENT)
(910) 484-2171
Entity
Organization
Contact information
Practice address
4140 FERNCREEK DR, SUITE 801, FAYETTEVILLE, NC 28314-2572
(910) 484-2171
(910) 484-4568
Mailing address
4140 FERNCREEK DR, SUITE 801, FAYETTEVILLE, NC 28314-2572
(910) 484-2171
(910) 484-4568
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XP3100X
Pediatric Orthopaedic Surgery Physician
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01185
BCBS GROUP ID NUMBER
NC
05
—
7901185
—
NC
Enumeration date
02/15/2006
Last updated
08/06/2019
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