Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 665 | SD |
NPI | 1619035326 |
---|---|
Provider Name | Dr. Roger Craig Gage |
First Address | Alexandria, VA 22306-7530 |
Second Address | Fort Belvoior, VA 22060-0003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7602650 | (05) | SD |