Organization
SOUTHEASTERN MEDICAL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HENRY LEPORE MD (OWNER)
(910) 575-5750
Entity
Organization
Contact information
Practice address
830 SUNSET BLVD N, SUNSET BEACH, NC 28468-4262
(910) 575-5750
(910) 575-5751
Mailing address
830 SUNSET BLVD N, SUNSET BEACH, NC 28468-4262
(910) 575-5750
(910) 575-5751
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
10022
NC
208100000X
Physical Medicine & Rehabilitation Physician
Primary
96-01376
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11413
BLUE CROSS DR LEPORE
NC
05
—
8911413
—
NC
Enumeration date
08/14/2006
Last updated
09/27/2010
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