Provider Demographics
NPI:1679772123
Name:MIDDLEBROOK, IGOR DUANE (DO)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:DUANE
Last Name:MIDDLEBROOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 MEDICAL OFFICE PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9417
Mailing Address - Country:US
Mailing Address - Phone:919-580-0008
Mailing Address - Fax:
Practice Address - Street 1:2700 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9494
Practice Address - Country:US
Practice Address - Phone:919-580-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-15
Last Update Date:2022-06-06
Deactivation Date:2018-03-20
Deactivation Code:
Reactivation Date:2018-03-28
Provider Licenses
StateLicense IDTaxonomies
MI5101023931207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty