Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 30215 | TN |
NPI | 1437159126 |
---|---|
Provider Name | Dr. Barry G Gilmore |
First Address | Arlington, TN 38002-5122 |
Second Address | Memphis, TN 38103-2816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 08/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G02245 | (02) | TN |