Provider Demographics
NPI:1629435714
Name:GAGNIER, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GAGNIER
Suffix:
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 1:220 VALLEY STREAM ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390
Mailing Address - Country:US
Mailing Address - Phone:206-234-4343
Mailing Address - Fax:
Practice Address - Street 1:GRUBER ROAD
Practice Address - Street 2:BUILDING #C-1722
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310
Practice Address - Country:US
Practice Address - Phone:910-907-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant