Organization
FUNDERBURK MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMON FUNDERBURK MD (OWNER)
(336) 659-9440
Entity
Organization
Contact information
Practice address
250 EXECUTIVE PARK BLVD, WINSTON SALEM, NC 27103-1534
(336) 659-9440
(336) 659-9845
Mailing address
250 EXECUTIVE PARK BLVD, WINSTON SALEM, NC 27103-1534
(336) 659-9440
(336) 659-9845
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15068
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34172
BCBSNC
NC
05
—
8934172
—
NC
Enumeration date
03/11/2008
Last updated
03/11/2008
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