Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 6516 | FL |
NPI | 1013028075 |
---|---|
Provider Name | Dr. Gerald Mcelroy Kluft |
First Address | Tampa, FL 33617-1906 |
Second Address | Tampa, FL 33617-1906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 09/07/2007 |