Provider Demographics
NPI:1821094327
Name:BADZINSKI, GARY LEE (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:LEE
Last Name:BADZINSKI
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 1:2300 RAMSEY ST
Mailing Address - Street 2:SUITE 304B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-3856
Mailing Address - Country:US
Mailing Address - Phone:910-488-2120
Mailing Address - Fax:910-482-5244
Practice Address - Street 1:2300 RAMSEY ST
Practice Address - Street 2:SUITE 304B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3856
Practice Address - Country:US
Practice Address - Phone:910-488-2120
Practice Address - Fax:910-482-5244
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-00150207RC0000X
OK3416207RC0000X
FLOS9663207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100088510AMedicaid
OKP00657417Medicare PIN
B45796Medicare UPIN
OKOK401299Medicare PIN
OK100088510AMedicaid