Individual ProviderRuth Iyun FagbemiFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address7300 S Raeford Rd, Fayetteville, NC 28304-6162(910) 475-6185PECOS EnrollmentBased on the most recent information from CMS, provider Ruth Iyun Fagbemi does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1013204932Provider TypeIndividualFull NameFagbemi, Ruth IyunCredentialM.DGenderFemaleSole ProprietorNoEnumeration Date6/29/2011Last Updated10/17/2019Contact InformationPractice LocationPractice Address7300 S Raeford Rd, Fayetteville, NC 28304-6162Phone(910) 475-6185FaxUnlisted FaxMailing LocationMailing Address2300 Ramsey St, Fayetteville, NC 28301-3856PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseR1524TexasCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseMT200451PennsylvaniaCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense47498KentuckyCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseR1524TexasProvider IdentifiersIDDescriptionIssuerID47498DescriptionOtherIssuerLICENSEKentuckyID7100314450DescriptionMedicaidIssuerUnlistedKentucky