Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 042.0012577 | VT |
N | 207P00000X | Emergency Physician | 40833 | AZ |
N | 207P00000X | Emergency Physician | 48971 | CO |
N | 207P00000X | Emergency Physician | MD2015-0100 | NM |
Y | 207PP0204X | Pediatric Emergency Physician | 16455 | NV |
N | 207PP0204X | Pediatric Emergency Physician | 27906 | NE |
NPI | 1699970830 |
---|---|
Provider Name | Charles P Gillespie |
First Address | Lafayette, CO 80026-3488 |
Second Address | Lafayette, CO 80026-3488 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 02/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
76686 | RESIDENT PG PERMIT (01) | AZ |