Individual
PAUL SAMUEL PEGRAM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
16925
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29201
MEDCOST
—
01
—
3528
PARTNERS
—
01
—
5529121
AETNA
—
05
—
6010016
—
VA
01
—
66717
BCBS
—
05
—
8966717
—
NC
05
—
Q16925
—
SC
Enumeration date
12/09/2005
Last updated
01/11/2008
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