Roy O Fagan Iii Md Pa | |
419 W Harrison St Reidsville NC 27320-5015 | |
(336) 342-4448 | |
(336) 342-4499 |
Full Name | Roy O Fagan Iii Md Pa |
---|---|
Speciality | Internal Medicine |
Location | 419 W Harrison St, Reidsville, North Carolina |
Authorized Official Name and Position | Roy O Fagan (PRESIDENT) |
Authorized Official Contact | 3363424448 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Roy O Fagan Iii Md Pa 419 W Harrison St Reidsville NC 27320-5015 Ph: (336) 342-4448 | Roy O Fagan Iii Md Pa 419 W Harrison St Reidsville NC 27320-5015 Ph: (336) 342-4448 |
NPI Number | 1023291234 |
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Provider Enumeration Date | 12/11/2007 |
Last Update Date | 12/11/2007 |
Medicare PECOS PAC ID | 5395770739 |
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Medicare Enrollment ID | O20051004000898 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023291234 | NPI | - | NPPES |
7931038 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 37825 (North Carolina) | Primary |
Provider Name | Roy O Fagan |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1023075140 PECOS PAC ID: 7113952565 Enrollment ID: I20051010000927 |
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