Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0101235533 | VA |
NPI | 1003819574 |
---|---|
Provider Name | Robert C Gard |
First Address | Roanoke, VA 24013-2218 |
Second Address | Roanoke, VA 24013-2218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 12/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010057418 | (05) | VA |
137067 | ANTHEM (01) | VA |
240864 | SOUTHERN HEALTH (01) | VA |
3312099 | CIGNA HEALTHCARE (01) | VA |
7775566 | AETNA (01) | VA |
H65882 | (02) | VA |
TN0117 | JOHN DEERE HEALTH CARE (01) | VA |