Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | DR.0058448 | CO |
Y | 111NI0900X | Internist | DR.0058448 | CO |
NPI | 1003233990 |
---|---|
Provider Name | Amanda Gelman |
First Address | Chinle, AZ 86503-8000 |
Second Address | Chinle, AZ 86503-8000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2014 |
Last Update Date | 28/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DR.0058448 | STATE LICENSE (01) | CO |