Individual
MR. REGINALD STYLES BAZEMORE II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1506 GOVERNORS RD, WINDSOR, NC 27983-9763
(919) 805-9379
Mailing address
1506 GOVERNORS RD, WINDSOR, NC 27983-9763
(919) 805-9379
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
26933646
NC
Other
Enumeration date
09/12/2013
Last updated
09/27/2013
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