Healthcare Provider Details

I. General information

NPI: 1750368221
Provider Name (Legal Business Name): JOHN F GAGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 N BROAD ST
SEAGROVE NC
27341-8583
US

IV. Provider business mailing address

218 FOUST ST STE C
ASHEBORO NC
27203-5476
US

V. Phone/Fax

Practice location:
  • Phone: 336-873-8045
  • Fax: 336-873-9074
Mailing address:
  • Phone: 336-625-2333
  • Fax: 336-625-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9501245
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: