Provider Demographics
NPI:1427156447
Name:ROXBORO MEDICAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:ROXBORO MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KAFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-598-6034
Mailing Address - Street 1:783 DOCTORS COURT, P.O. BOX 1058
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-4571
Mailing Address - Country:US
Mailing Address - Phone:336-598-6034
Mailing Address - Fax:336-598-6025
Practice Address - Street 1:783 DOCTORS COURT
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4571
Practice Address - Country:US
Practice Address - Phone:336-598-6034
Practice Address - Fax:336-598-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCREGCERT40967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1427156447OtherRAILROAD MEDICARE
NC890238CMedicaid
NC890238CMedicaid
NC1427156447OtherRAILROAD MEDICARE