Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 37964 | CO |
NPI | 1174576037 |
---|---|
Provider Name | Dr. Richard Gamuac |
First Address | Pueblo, CO 81003-2644 |
Second Address | Pueblo, CO 81003-2644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 26/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
70381348 | (05) | CO |
H60610 | (02) |