Basic Information
Provider Information
NPI: 1164469920
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NOR
FirstName: EUGENE
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 60 COMMERCE PLZ
Address2:  
City: PEMBROKE
State: NC
PostalCode: 283727386
CountryCode: US
TelephoneNumber: 9105212900
FaxNumber: 9107759165
Practice Location
Address1: 610 E DR MARTIN LUTHER KING JR DR
Address2:  
City: MAXTON
State: NC
PostalCode: 283641800
CountryCode: US
TelephoneNumber: 9108445253
FaxNumber: 9108443290
Other Information
ProviderEnumerationDate: 06/01/2006
LastUpdateDate: 09/16/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/16/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X2010-01329NCY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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