Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 10945 | WV |
NPI | 1043213762 |
---|---|
Provider Name | Dr. Henry P Gosiene |
First Address | Beckley, WV 25801-3615 |
Second Address | Beckley, WV 25801-3615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 19/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0095654000 | (05) | WV |
D49246 | (02) |