Provider Demographics
NPI:1578759106
Name:ROBESON DIGESTIVE DISEASES
Entity Type:Organization
Organization Name:ROBESON DIGESTIVE DISEASES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-739-8825
Mailing Address - Street 1:1011 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3328
Mailing Address - Country:US
Mailing Address - Phone:910-739-8825
Mailing Address - Fax:
Practice Address - Street 1:1011 WOODRIDGE DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3328
Practice Address - Country:US
Practice Address - Phone:910-739-8825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29856261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8952432Medicaid
203649CMedicare PIN