MR. GARY ROBERTSON I.D.C NPI 1790034296

NPI Information

  • NPI: 1790034296
  • Provider Name: MR. GARY ROBERTSON, I.D.C
  • Classification: Physician Assistant - 363AM0700X
  • Specialization: Medical
  • Entity Type: Individual
  • Address: 1059 USS MARIANO VILLEJO AVE
    KINGS BAY, GA
    ZIP 31547
  • Phone: (912) 573-6599

Map and Directions

Get Directions

NPI Details

MR. Gary Robertson, I.D.C is a medical physician assistant in Kings Bay, GA. MR. Gary Robertson, I.D.C NPI is 1790034296. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1059 USS MARIANO VILLEJO AVE
KINGS BAY, GA
ZIP 31547
Phone: (912) 573-6599

The enumeration date for this NPI number is 8/30/2012 and was last updated on 3/31/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedicalCONNECTICUTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11132OTHERFLORIDAUS NAVY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI