Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 0101-235394 | VA |
NPI | 1063495570 |
---|---|
Provider Name | Dr. Gary R Simonds |
First Address | Roanoke, VA 24016 |
Second Address | Roanoke, VA 24016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 12/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010015316 | (05) | VA |
G04213 | (02) | VA |