Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 4996 | AZ |
Y | 111NN0400X | Neurology | 4996 | AZ |
NPI | 1891752382 |
---|---|
Provider Name | Dr. Gerald Kevin Gifford |
First Address | Mesa, AZ 85204-6266 |
Second Address | Mesa, AZ 85204-6266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 09/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
498502 | (05) | AZ |