Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 21586 | TX |
Y | 204E00000X | Oral & Maxillofacial Surgeon | N1443 | TX |
NPI | 1447469762 |
---|---|
Provider Name | Dr. Gilbert Tremayne Selkin |
First Address | Plano, TX 75024-7531 |
Second Address | Plano, TX 75024-3397 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 15/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OTH020 | (02) | TX |