Provider Demographics
NPI:1730371428
Name:HEMBREE, GARY WAYNE (SFIDC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:WAYNE
Last Name:HEMBREE
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22618 CLAIRWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1982
Mailing Address - Country:US
Mailing Address - Phone:586-601-6553
Mailing Address - Fax:
Practice Address - Street 1:22618 CLAIRWOOD ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1982
Practice Address - Country:US
Practice Address - Phone:586-601-6553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman