Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 0125765A | IN |
NPI | 1023198348 |
---|---|
Provider Name | Dr. James E. Gluckin |
First Address | Elkhart, IN 46514-1420 |
Second Address | Elkhart, IN 46514-1420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 28/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D69489 | (02) |