Provider Demographics
NPI:1538749528
Name:OPHAUG, ALEXIS (DO)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:OPHAUG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 SIX FORKS RD STE 111
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-8228
Mailing Address - Country:US
Mailing Address - Phone:919-787-9555
Mailing Address - Fax:
Practice Address - Street 1:5904 SIX FORKS RD STE 111
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-8228
Practice Address - Country:US
Practice Address - Phone:724-541-8572
Practice Address - Fax:919-510-5111
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-02205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics