Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 1341 | VI |
NPI | 1013022698 |
---|---|
Provider Name | Dr. Kelvin Devane Gipson |
First Address | Argyle, FL 32422-0123 |
Second Address | Bonifay, FL 32425-4264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 31/08/2010 |