Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | ME83504 | FL |
NPI | 1013961283 |
---|---|
Provider Name | Dr. Michael Dow Gilmore |
First Address | Crestview, FL 32539-7380 |
Second Address | Crestview, FL 32539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 23/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43258 | INDIVIDUAL BLUE CROSS (01) | FL |
I09378 | (02) | FL |