Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 2020-03139 | NC |
NPI | 1639406598 |
---|---|
Provider Name | Daniel Robert Gerry |
First Address | Monroe, NC 28112-4351 |
Second Address | Monroe, NC 28112-4351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2009 |
Last Update Date | 08/02/2021 |