Provider Demographics
NPI:1942524129
Name:PROGRESS WEIGHT LOSS, PC
Entity Type:Organization
Organization Name:PROGRESS WEIGHT LOSS, PC
Other - Org Name:PROGRESS WEIGHT LOSS SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-781-0815
Mailing Address - Street 1:2801 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6474
Mailing Address - Country:US
Mailing Address - Phone:919-781-0185
Mailing Address - Fax:919-780-0816
Practice Address - Street 1:4207 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6684
Practice Address - Country:US
Practice Address - Phone:919-780-0815
Practice Address - Fax:919-781-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400388208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty