| Organization Name: | THE FAMILY DOC BACK TO BASICS MEDICAL PRACTICE, PLLC |
| NPI Number: | 1518343573 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT WILLIAM PATTERSON (MEDICAL DIRECTOR) |
| Mailing Address: | 1503 Elm Street, Suite C Sanford |
| State: | NC US |
| Postal Code: | 27330 |
| Phone Number: | 9198956339 |
| Fax Number: | 9195901981 |
| NPI Enumeration Date: | 07/31/2015 |
| NPI Last Update Date: | 07/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 23907 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |