Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 26772 | IA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 26772 | IA |
N | 207NP0225X | Pediatric Dermatologist | 26772 | IA |
N | 207NS0135X | Procedural Dermatology | 26772 | IA |
NPI | 1508811076 |
---|---|
Provider Name | Bryon L Gaul |
First Address | Spencer, IA 51301 |
Second Address | Spencer, IA 51301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 28/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0268979 | (05) | IA |
D25899 | (02) | IA |