Individual
JONATHAN BAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
300 W 27TH ST, LUMBERTON, NC 28358-3075
(910) 738-2662
(910) 272-7153
Mailing address
300 W 27TH ST, LUMBERTON, NC 28358-3075
(910) 738-2662
(910) 272-7153
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
219504
NC
Other
Enumeration date
06/01/2016
Last updated
12/27/2016
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