Provider Demographics
NPI:1568972982
Name:PENAFLOR, EDGAR JUDE ARROYO JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EDGAR JUDE
Middle Name:ARROYO
Last Name:PENAFLOR
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 ROSETTA DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2324
Mailing Address - Country:US
Mailing Address - Phone:775-720-5255
Mailing Address - Fax:
Practice Address - Street 1:351 WELLESLEY TRADE LN
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-5669
Practice Address - Country:US
Practice Address - Phone:919-576-8100
Practice Address - Fax:919-576-8149
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07604363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant