Healthcare Provider Details

I. General information

NPI: 1659313054
Provider Name (Legal Business Name): ROBINSON M. GILMORE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 RIDGEWAY AVENUE
CHARLOTTE NC
28204
US

IV. Provider business mailing address

429 RIDGEWAY AVENUE
CHARLOTTE NC
28204
US

V. Phone/Fax

Practice location:
  • Phone: 704-962-2688
  • Fax: 704-405-5927
Mailing address:
  • Phone: 704-962-2688
  • Fax: 704-405-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0199297
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: