Individual
HENRY TELLEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
295 OLMSTED BLVD, MELLON BLDG. STE. 12, PINEHURST, NC 28374-9131
(910) 235-0535
(910) 235-0546
Mailing address
295 OLMSTED BLVD, MELLON BLDG. STE. 12, PINEHURST, NC 28374-9131
(910) 235-0595
(910) 235-0546
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
9500740
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130022118
RAIL ROAD MEDICARE
NC
01
—
82328
BLUE CROSS BLUE SHIELD NC
NC
05
—
8982328
—
NC
Enumeration date
12/01/2006
Last updated
12/21/2020
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