Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5457 | AZ |
NPI | 1124123005 |
---|---|
Provider Name | Dr. Gregory A Libby |
First Address | Phoenix, AZ 85050-4256 |
Second Address | Phoenix, AZ 85050-4256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |