Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 01056296 | IN |
NPI | 1033451083 |
---|---|
Provider Name | Dr. Richard Brian Gaynor |
First Address | Indianapolis, IN 46285-0001 |
Second Address | Indianapolis, IN 46285-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2013 |
Last Update Date | 17/03/2013 |