Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 0101050099 | VA |
NPI | 1245277037 |
---|---|
Provider Name | Gary Paige Rakes |
First Address | Skyland, NC 28776-2153 |
Second Address | Charlottesville, VA 22911-3642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 07/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00Y223A01 | MEDICARE PTAN (01) | VA |
1245277037 | (05) | VA |
192050 | ANTHEM (01) | VA |
414725 | SOUTHERN HEALTH (01) | VA |
5057181 | AETNA USHC (01) | VA |
F40818 | (02) |