Provider Demographics
NPI:1114034246
Name:DALE WELLS CAUGHEY, MD, PC
Entity Type:Organization
Organization Name:DALE WELLS CAUGHEY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:W
Authorized Official - Last Name:CAUGHEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:910-799-4220
Mailing Address - Street 1:PO BOX 4667
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-4667
Mailing Address - Country:US
Mailing Address - Phone:910-799-4220
Mailing Address - Fax:910-799-0460
Practice Address - Street 1:5305 A WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6530
Practice Address - Country:US
Practice Address - Phone:910-799-4220
Practice Address - Fax:910-799-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8921738Medicaid
NC21738OtherBLUE CROSS
NC7557727OtherCIGNA
NC589598OtherUNITED HEALTH CARE
NC201345BMedicare PIN
NC8921738Medicaid