Individual
GARY R FENDER
Active
Individual
GARY R FENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101034449
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11007547
RR MEDICARE
—
05
—
6072291
—
VA
Enumeration date
08/04/2006
Last updated
12/01/2014
Update your record
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