Provider Demographics
NPI:1609903228
Name:NORTH RALEIGH FAMILY MEDICINE
Entity Type:Organization
Organization Name:NORTH RALEIGH FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-841-4566
Mailing Address - Street 1:8331 BANDFORD WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2758
Mailing Address - Country:US
Mailing Address - Phone:919-841-4566
Mailing Address - Fax:919-841-4568
Practice Address - Street 1:8331 BANDFORD WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2758
Practice Address - Country:US
Practice Address - Phone:919-841-4566
Practice Address - Fax:919-841-4568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35144207Q00000X
NC67397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS01783Medicare UPIN
NCF33350Medicare UPIN