Healthcare Provider Details

I. General information

NPI: 1518965896
Provider Name (Legal Business Name): ALAN LANIER GABBARD II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 03/07/2023
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W MCCREIGHT AVE STE 211
SPRINGFIELD OH
45504-1853
US

IV. Provider business mailing address

247 S BURNETT RD SUITE 120
SPRINGFIELD OH
45505-2639
US

V. Phone/Fax

Practice location:
  • Phone: 937-325-3696
  • Fax: 937-325-3713
Mailing address:
  • Phone: 937-324-5834
  • Fax: 937-324-5832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.041436
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35041436-G
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: