Provider Demographics
NPI:1710943212
Name:MCCONEKEY, ROBERT (DPM)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:MCCONEKEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-8022
Mailing Address - Country:US
Mailing Address - Phone:910-763-7578
Mailing Address - Fax:910-763-9320
Practice Address - Street 1:920 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-8022
Practice Address - Country:US
Practice Address - Phone:910-763-7578
Practice Address - Fax:910-763-9320
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC465213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890808UMedicaid
NC0808UOtherINDIVIDUAL - BCBS
NC890808UMedicaid
NC0808UOtherINDIVIDUAL - BCBS