Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist |
NPI | 1063789691 |
---|---|
Provider Name | Dara Gibbs |
First Address | Louisville, KY 40206-1433 |
Second Address | Louisville, KY 40206-1433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2011 |
Last Update Date | 28/11/2011 |