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
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
Other
Enumeration date
06/28/2010
Last updated
11/05/2010
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