Provider Demographics
NPI:1679630107
Name:ROOKER, GARY MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MICHAEL
Last Name:ROOKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3612
Mailing Address - Country:US
Mailing Address - Phone:540-381-5832
Mailing Address - Fax:
Practice Address - Street 1:102 MILLER ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3612
Practice Address - Country:US
Practice Address - Phone:540-381-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01020501572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
193972000OtherMAGELLAN
098613OtherVALUE OPTIONS
VA7113048Medicaid
VA208744OtherANTHEM BLUE CROSS SHIELD
VA208744OtherANTHEM BLUE CROSS SHIELD
260002719Medicare ID - Type Unspecified