Provider Demographics
NPI:1427477025
Name:LIMBAUGH, GARY KEN JR (MS, LAT, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:KEN
Last Name:LIMBAUGH
Suffix:JR
Gender:M
Credentials:MS, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SOI-E P.O. BOX 20161
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542
Mailing Address - Country:US
Mailing Address - Phone:910-449-0494
Mailing Address - Fax:
Practice Address - Street 1:G544 C STREET
Practice Address - Street 2:
Practice Address - City:CAMP OLEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542
Practice Address - Country:US
Practice Address - Phone:910-449-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2222171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider