Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 292965-1 | NY |
NPI | 1295072601 |
---|---|
Provider Name | Dr. Hunter Azdel Gomez Roberts |
First Address | Detroit, MI 48207-2968 |
Second Address | Buffalo, NY 14203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2013 |
Last Update Date | 21/06/2018 |