Doctor Name: | DR. MAURICE KOBLA KPEGLO |
NPI Number: | 1063590479 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 29314 |
Business Practice Address: | 2025 Martin L King Jr Dr Suite E Greensboro, NC - 274063334 |
Business Phone Number: | 3363780760 |
Business Fax Number: | 3363780970 |
Mailing Address: | Po Box 14914, GREENSBORO |
State: | NC |
Postal Code: | 274154914 |
Phone Number: | 3363780760 |
Fax Number: | 3363780970 |
NPI Enumeration Date: | 11/02/2006 |
NPI Last Update Date: | 06/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 29314 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |