Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH6154 | FL |
NPI | 1679596522 |
---|---|
Provider Name | Dr. Bruce A Gifford |
First Address | Naples, FL 34116-6962 |
Second Address | Naples, FL 34116-6962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 13/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22578 | BCBS OF FLORIDA (01) | FL |
3804526-00 | (05) | FL |
U-10200 | (02) | FL |