Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0200X | Radiology | 08002219A | IN |
N | 213ER0200X | Radiology | 08002219A | IN |
Y | 111NR0200X | Radiology | 4777 | KY |
Y | 213ER0200X | Radiology | 4777 | KY |
NPI | 1679568059 |
---|---|
Provider Name | Dr. Brooke L Gajeski |
First Address | Harrods Creek, KY 40027-0410 |
Second Address | Prospect, KY 40059-7515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 20/10/2017 |