Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 11317 | TX |
NPI | 1023120151 |
---|---|
Provider Name | Dr. John David Gebhard |
First Address | Sherman, TX 75092-2204 |
Second Address | Sherman, TX 75090-3111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |