Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 2017016028 | MO |
NPI | 1003336843 |
---|---|
Provider Name | David Rhea Gilley |
First Address | Columbia, MO 65212-1000 |
Second Address | Columbia, MO 65212-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2017 |
Last Update Date | 22/06/2017 |