Provider Demographics
NPI:1285684951
Name:BOARD, ROBERT JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JEFFREY
Last Name:BOARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 EXECUTIVE DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7445
Mailing Address - Country:US
Mailing Address - Phone:919-876-2427
Mailing Address - Fax:919-790-8423
Practice Address - Street 1:3320 EXECUTIVE DR
Practice Address - Street 2:SUITE 111
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7445
Practice Address - Country:US
Practice Address - Phone:919-876-2427
Practice Address - Fax:919-790-8423
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23007207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-16392Medicaid
NC89-16392Medicaid
203269AMedicare ID - Type Unspecified