Organization
OLD TOWN FAMILY MEDICINE, P A
Active
Organization
OLD TOWN FAMILY MEDICINE, P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD RAY HERBER MD (PRESIDENT)
(336) 922-1363
Entity
Organization
Contact information
Practice address
3690 REYNOLDA RD, WINSTON SALEM, NC 27106-2230
(336) 922-1363
Mailing address
3690 REYNOLDA RD, WINSTON SALEM, NC 27106-2230
(336) 922-1363
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
39614
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8941873
—
NC
Enumeration date
03/29/2007
Last updated
01/26/2012
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