Funderburk MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

15068 Issued in NC

Legal business name

FUNDERBURK MD

Practice address

250 Executive Park Blvd
Winston Salem, NC 27103-1534

Phone

(336) 659-9440

Fax

(336) 659-9845

NPI assigned

Mar 11, 2008

Last updated

Mar 11, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Amon Funderburk, MD

Title

Owner

Phone

(336) 659-9440

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205193600000",
    "number": "1841460326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 EXECUTIVE PARK BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031534",
            "telephone_number": "336-659-9440",
            "fax_number": "336-659-9845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 EXECUTIVE PARK BLVD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271031534",
            "telephone_number": "336-659-9440",
            "fax_number": "336-659-9845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNDERBURK MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-11",
        "last_updated": "2008-03-11",
        "status": "A",
        "authorized_official_last_name": "FUNDERBURK",
        "authorized_official_first_name": "AMON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-659-9440",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "15068",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8934172",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "34172",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Denise V Fulller
• Fulp Therapy Services, Inc.
• Andrew G Fulp, PA-C
• Nanette Nicole Fulp, PA-C
• Juwan Fulton
• Whitney Bond Funderburk
• Jennifer Fuqua, PA-C
• Micaela Furest Cataldo
• Sheleena Renee Furner, AGPCNP-C
• Adam Furr, PHARMD

• Internal Medicine Physician in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.