Provider Demographics
NPI:1336126622
Name:ALEXANDER EPPERLY, ALEXIS T (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:T
Last Name:ALEXANDER EPPERLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:120 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6328
Mailing Address - Country:US
Mailing Address - Phone:910-353-0581
Mailing Address - Fax:910-353-1536
Practice Address - Street 1:1106 MAIN STREET EXT
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-9114
Practice Address - Country:US
Practice Address - Phone:910-325-0581
Practice Address - Fax:910-325-0582
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01916207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF352AOtherMEDICARE PTAN