Provider Demographics
NPI:1417430646
Name:GAYLES, BRIAN ANTHONY SR
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ANTHONY
Last Name:GAYLES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6224 OLD MILL RD APT B14
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4246
Mailing Address - Country:US
Mailing Address - Phone:434-262-2304
Mailing Address - Fax:
Practice Address - Street 1:6224 OLD MILL RD APT B14
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4246
Practice Address - Country:US
Practice Address - Phone:434-262-2304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver