Individual
JOSE PLAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2817 ROCK MERRITT AVE, FORT BRAGG, NC 28310-0001
(910) 907-8922
(910) 907-6069
Mailing address
2817 ROCK MERRITT AVE, FORT BRAGG, NC 28310-0001
(910) 907-8922
(910) 907-6069
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
9700713
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142252
—
SC
05
—
8968376
—
NC
05
—
N00713
—
SC
Enumeration date
07/08/2006
Last updated
04/15/2025
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