Provider Demographics
NPI:1528543709
Name:GAGE, ROBERT L (RN, BSN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:GAGE
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3214
Mailing Address - Country:US
Mailing Address - Phone:903-948-2723
Mailing Address - Fax:
Practice Address - Street 1:718 BELMONT ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3214
Practice Address - Country:US
Practice Address - Phone:903-948-2723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX784840163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse