Provider Demographics
NPI:1518965896
Name:GABBARD, ALAN LANIER II (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:LANIER
Last Name:GABBARD
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:247 S BURNETT RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45505-2639
Mailing Address - Country:US
Mailing Address - Phone:937-324-5834
Mailing Address - Fax:937-324-5832
Practice Address - Street 1:30 W MCCREIGHT AVE STE 211
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1853
Practice Address - Country:US
Practice Address - Phone:937-325-3696
Practice Address - Fax:937-325-3713
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.041436207RG0100X
OH35041436-G174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0450855Medicaid
OH0450855Medicaid
OHGA0454512Medicare UPIN