Provider Demographics
NPI:1821012949
Name:HARGROVE, GAIL (PA-C)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 22ND PL
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1314
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:3514 21ST ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1210
Practice Address - Country:US
Practice Address - Phone:806-725-1801
Practice Address - Fax:806-723-7535
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01779363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118678100OtherFIRSTCARE
S80537Medicare UPIN
8C0430Medicare ID - Type Unspecified