Provider Demographics
NPI:1841212578
Name:GIST, RICHARD SPENCER (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SPENCER
Last Name:GIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:GIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2430 EMERALD PL STE 201
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5743
Mailing Address - Country:US
Mailing Address - Phone:252-752-2140
Mailing Address - Fax:252-565-8463
Practice Address - Street 1:2430 EMERALD PL STE 201
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5743
Practice Address - Country:US
Practice Address - Phone:252-752-2140
Practice Address - Fax:252-565-8463
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021193207LC0200X
VA0101268685207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1920983Medicaid
LA1920983Medicaid
5U940Medicare ID - Type Unspecified