Healthcare Provider Details

I. General information

NPI: 1538196209
Provider Name (Legal Business Name): GARY A RANKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 MAPLE ST
GREENSBORO NC
27405-6911
US

IV. Provider business mailing address

1204 MAPLE ST
GREENSBORO NC
27405-6911
US

V. Phone/Fax

Practice location:
  • Phone: 336-294-8258
  • Fax: 336-292-4109
Mailing address:
  • Phone: 336-294-8258
  • Fax: 336-292-4109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35475
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: