Individual
GARY NACE
Active
Individual
GARY NACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036108353
IL
207R00000X
Internal Medicine Physician
Primary
14813
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00055091
—
MS
05
—
036108353
—
IL
01
—
07215036
BCBS
IL
05
—
187949001
—
AR
05
—
3020124
—
TN
01
—
4300658
BCBS
TN
01
—
IL01CY
JOHN DEERE
IL
Enumeration date
03/10/2006
Last updated
12/17/2015
Update your record
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