Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D8916 | OR |
NPI | 1023280344 |
---|---|
Provider Name | Dr. Gabriel M Kennedy |
First Address | Albany, OR 97321-7539 |
Second Address | Albany, OR 97321-7539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2008 |
Last Update Date | 23/06/2010 |