MEDICARE: DR. ALAN LANIER GABBARD II MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	35.041436	OH
2	174400000X	Specialist	35041436-G	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518965896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN LANIER GABBARD II MD

Provider Business Mailing Address
First Line	:	247 S BURNETT RD
Second Line	:	SUITE 120
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-2639
Country	:	US
Telephone Number	:	937-324-5834
Fax Number	:	937-324-5832

Provider Business Practice Location Address
First Line	:	30 W MCCREIGHT AVE STE 211
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-1853
Country	:	US
Telephone Number	:	937-325-3696
Fax Number	:	937-325-3713

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	03/07/2023

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