Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 200001205450 | NC |
NPI | 1578504726 |
---|---|
Provider Name | Dr. Gilson John Kingman |
First Address | Winston Salem, NC 27103 |
Second Address | Winston Salem, NC 27103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 17/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
49032 | BCBS (01) | NC |
8798 | PARTNERS (01) | NC |
8949032 | (05) | NC |
B0941 | MECOST (01) | NC |
F90557 | (02) | |
P00024584 | RAILROAD MEDICARE (01) |