Provider Demographics
NPI:1194057562
Name:BAYSDON, ROBERT W
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:BAYSDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3576
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-3576
Mailing Address - Country:US
Mailing Address - Phone:910-865-9000
Mailing Address - Fax:910-865-9004
Practice Address - Street 1:2818 W BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-0000
Practice Address - Country:US
Practice Address - Phone:910-247-6100
Practice Address - Fax:910-247-6106
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier