Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 30580 | TX |
NPI | 1538504741 |
---|---|
Provider Name | Dr. Corbin A. Gatlin |
First Address | Waco, TX 76712-3100 |
Second Address | Waco, TX 76712-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2013 |
Last Update Date | 22/06/2019 |