Provider Demographics
NPI:1245235928
Name:MIDDLETON, ROY BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:BRUCE
Last Name:MIDDLETON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:MT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-1267
Mailing Address - Country:US
Mailing Address - Phone:336-786-7669
Mailing Address - Fax:336-719-2492
Practice Address - Street 1:708 S SOUTH ST
Practice Address - Street 2:STE 100
Practice Address - City:MT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-4426
Practice Address - Country:US
Practice Address - Phone:336-789-9176
Practice Address - Fax:336-789-9178
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23618208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891047MMedicaid
C67521Medicare UPIN
NC208852DMedicare PIN