Provider Demographics
NPI:1821192154
Name:BJARNASON, GARY F
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:F
Last Name:BJARNASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:F
Other - Last Name:BJARNASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:240 SMITH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4903
Mailing Address - Country:US
Mailing Address - Phone:252-535-2004
Mailing Address - Fax:252-535-9154
Practice Address - Street 1:240 SMITH CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4903
Practice Address - Country:US
Practice Address - Phone:252-535-2004
Practice Address - Fax:252-535-9154
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2008-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC237213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0801GOtherBCBS OF NC
77489OtherMEDCOST
4545795002OtherCIGNA
480033405OtherRAILROAD
243143OtherMEDICARE
NC890801GMedicaid
77489OtherMEDCOST
NC0801GOtherBCBS OF NC
NC890801GMedicaid