Provider Demographics
NPI:1154364388
Name:ROPER, GARY WAYNE (GARY ROPER)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:WAYNE
Last Name:ROPER
Suffix:
Gender:M
Credentials:GARY ROPER
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:WAYNE
Other - Last Name:ROPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:NC
Mailing Address - Zip Code:28901-0550
Mailing Address - Country:US
Mailing Address - Phone:828-321-4510
Mailing Address - Fax:828-321-3973
Practice Address - Street 1:2751 BUSINESS HWY 19
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:NC
Practice Address - Zip Code:28901
Practice Address - Country:US
Practice Address - Phone:828-321-4510
Practice Address - Fax:828-321-3973
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39876207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010041977OtherRAILROAD
NC8973103Medicaid
NC8973103Medicaid
NCE75937Medicare UPIN