Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CH7736 | FL |
NPI | 1245243054 |
---|---|
Provider Name | Dr. Joseph P Gambardella |
First Address | Miami, FL 33183-2808 |
Second Address | Miami, FL 33183-2808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55881 | BLUE CROSS BLUE SHIELD (01) | FL |
U98663 | (02) | FL |