Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | ME125107 | FL |
N | 208D00000X | General Practice Physician | 28753-R | PR |
NPI | 1023391059 |
---|---|
Provider Name | Dr. Jaime R. Gierbolini |
First Address | Clearwater, FL 33757-8744 |
Second Address | Riverview, FL 33578-7422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2011 |
Last Update Date | 07/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021969100 | (05) | FL |