Organization
WAKE SPECIALTY PHYSICIANS, LLC
Active
Organization
WAKE SPECIALTY PHYSICIANS, LLC
Active
Other names
WPP Wake Ortho
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA JAYOUSSI (EXECUTIVE DIRECTOR FINANCE)
(919) 350-6089
Entity
Organization
Contact information
Practice address
8001 T W ALEXANDER DR, SUITE 224, RALEIGH, NC 27617-8768
(919) 232-5020
Mailing address
PO BOX 602195, CHARLOTTE, NC 28260-2195
(919) 350-0554
(919) 350-7687
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942440375
—
NC
01
—
7108950002
DME PTAN
NC
Enumeration date
07/11/2014
Last updated
10/16/2017
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