Provider Demographics
NPI:1588670236
Name:PRIOR, GARY B (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:B
Last Name:PRIOR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1946 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7306
Mailing Address - Country:US
Mailing Address - Phone:909-793-0141
Mailing Address - Fax:
Practice Address - Street 1:11201 BENTON ST
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:02357
Practice Address - Country:US
Practice Address - Phone:909-583-6067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1447367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered