Provider Demographics
NPI:1780671016
Name:WILLIFORD, ROBERT EARL JR (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EARL
Last Name:WILLIFORD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:230 FOUST ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5404
Mailing Address - Country:US
Mailing Address - Phone:336-633-0407
Mailing Address - Fax:336-633-0410
Practice Address - Street 1:230 FOUST ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5404
Practice Address - Country:US
Practice Address - Phone:336-633-0407
Practice Address - Fax:336-633-0410
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC10331207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8988070Medicaid
NC200943Medicare ID - Type Unspecified
C84796Medicare UPIN