Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | A22566 | CA |
NPI | 1033128673 |
---|---|
Provider Name | Dr. Gary Kenneth Hargrove |
First Address | Fairview Heights, IL 62208-4502 |
Second Address | Salt Lake City, UT 84107-2192 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 12/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000272633 | HMSA (01) | HI |
A23148 | (02) | HI |