Basic Information
Provider Information
NPI: 1184795031
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DRIVER
FirstName: ROBERT
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3101 LATROBE DR
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282114849
CountryCode: US
TelephoneNumber: 7043767362
FaxNumber: 7043761939
Practice Location
Address1: 3101 LATROBE DR
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282114849
CountryCode: US
TelephoneNumber: 7043767362
FaxNumber: 7043761939
Other Information
ProviderEnumerationDate: 11/13/2006
LastUpdateDate: 08/21/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X2005-00515NCY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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