Provider Demographics
NPI:1700236445
Name:GIFFORD, ROBERT CHASE
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHASE
Last Name:GIFFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 COMER DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-8525
Mailing Address - Country:US
Mailing Address - Phone:931-698-3467
Mailing Address - Fax:
Practice Address - Street 1:2815 COMER DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-8525
Practice Address - Country:US
Practice Address - Phone:931-698-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator