Organization
WAKE UROLOGICAL ASSOCIATES, P.A.
Active
Organization
WAKE UROLOGICAL ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM JAMES MOUNTFORD JR. (PRACTICE ADMINISTRATOR)
(919) 782-1255
Entity
Organization
Contact information
Practice address
4301 LAKE BOONE TRL, SUITE 300, RALEIGH, NC 27607-7507
(919) 782-1255
(919) 782-6056
Mailing address
4301 LAKE BOONE TRL, SUITE 300, RALEIGH, NC 27607-7507
(919) 782-1255
(919) 782-6056
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
200001388680
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01928
BCBS GROUP NUMBER
NC
05
—
8901928
—
NC
Enumeration date
12/08/2006
Last updated
08/22/2020
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