Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | D0074165 | MD |
N | 207U00000X | Nuclear Medicine Specialist | ME119590 | FL |
NPI | 1669640348 |
---|---|
Provider Name | Dr. Kenneth Leslie Gage |
First Address | Tampa, FL 33612-9416 |
Second Address | Tampa, FL 33612-9416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2008 |
Last Update Date | 21/07/2014 |