Provider Demographics
NPI:1639384936
Name:EVERETT, ROBERT SCOTT (MD, PHARM D)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
Last Name:EVERETT
Suffix:
Gender:M
Credentials:MD, PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 BRENTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-2620
Mailing Address - Country:US
Mailing Address - Phone:336-768-9806
Mailing Address - Fax:336-768-9806
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-4626
Practice Address - Fax:336-716-5438
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC127625207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2069696BMedicare PIN