Organization Name: | MAURICE K. KPEGLO |
NPI Number: | 1497975411 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MAURICE KOBLA KPEGLO (PHYSICIAN/OWNER) |
Mailing Address: | 2025 Martin L. King Jr Dr. Suite-e Greensboro |
State: | NC US |
Postal Code: | 274063334 |
Phone Number: | 3363780760 |
Fax Number: | 3363780970 |
NPI Enumeration Date: | 05/01/2007 |
NPI Last Update Date: | 09/09/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 200001360016 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |