Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 2014012495 | MO |
Y | 207QS0010X | Family Doctor - Sports Medicine | 20140124955 | MO |
NPI | 1144532490 |
---|---|
Provider Name | Dr. Eric M Gifford |
First Address | Springfield, MO 65810 |
Second Address | Springfield, MO 65810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1144532490 | (05) | MO |
200015259 | (05) | MO |