Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD467606 | PA |
NPI | 1003296625 |
---|---|
Provider Name | Dr. Justin Michael Gamez |
First Address | Philadelphia, PA 19140-5103 |
Second Address | Philadelphia, PA 19134-4427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2015 |
Last Update Date | 14/08/2019 |