Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 4301050166 | MI |
NPI | 1356332746 |
---|---|
Provider Name | Dr. Carol Gordon Devore |
First Address | Beverly Hills, MI 48025-5471 |
Second Address | Beverly Hills, MI 48025-5471 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E49549 | (02) |