Basic Information
| Provider Information | |||||||||
| NPI: | 1588986616 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | R HENRY TEMPLE, MD., PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1606 PHYSICIANS DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284017361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103628765 | ||||||||
| FaxNumber: | 9103629123 | ||||||||
| Practice Location | |||||||||
| Address1: | 507 E FREMONT ST | ||||||||
| Address2: | |||||||||
| City: | BURGAW | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284255131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102592181 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2010 | ||||||||
| LastUpdateDate: | 02/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | TEMPLE | ||||||||
| AuthorizedOfficialFirstName: | RUFUS | ||||||||
| AuthorizedOfficialMiddleName: | HENRY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CEO | ||||||||
| AuthorizedOfficialTelephone: | 9103628765 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 20978 | NC | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 5911618 | 05 | NC | MEDICAID |