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NPI Code Detail

MEDICARE: DR. GARY GLENN GAMMON MD

MEDICARE: DR. GARY GLENN GAMMON 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
1207R00000XInternal Medicine Physician39942NC

Other Identifiers

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

General Provider Information

NPI Number : 1427044163
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY GLENN GAMMON MD
Provider Business Mailing Address
First Line : 2240 REMOUNT RD
Second Line :
City : GASTONIA
State : NC
Zip : 28054-4725
Country : US
Telephone Number : 704-671-5311
Fax Number : 704-671-5308
Provider Business Practice Location Address
First Line : 2240 REMOUNT RD
Second Line :
City : GASTONIA
State : NC
Zip : 28054-4725
Country : US
Telephone Number : 704-671-5344
Fax Number : 704-671-5331
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 07/09/2007

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