Organization
OWEN DRIVE SURGICAL CLINIC OF FAYETTEVILLE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BUNNY MARIE PERE (OFFICE MANAGER)
(910) 323-0101
Entity
Organization
Contact information
Practice address
513 OWEN DR, FAYETTEVILLE, NC 28304-3433
(910) 323-0101
(910) 484-2654
Mailing address
513 OWEN DR, FAYETTEVILLE, NC 28304-3433
(910) 323-0101
(910) 484-2654
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017XC
BCBS
NC
Enumeration date
10/31/2006
Last updated
08/22/2020
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