Provider Demographics
NPI:1659313054
Name:GILMORE, ROBINSON M (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ROBINSON
Middle Name:M
Last Name:GILMORE
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 1:429 RIDGEWAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204
Mailing Address - Country:US
Mailing Address - Phone:704-962-2688
Mailing Address - Fax:704-405-5927
Practice Address - Street 1:429 RIDGEWAY AVENUE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204
Practice Address - Country:US
Practice Address - Phone:704-962-2688
Practice Address - Fax:704-405-5927
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0199297367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8052225Medicaid
SCNAN744Medicaid
2608640Medicare PIN