Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2018013765 | MO |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 12214A | WY |
NPI | 1164865796 |
---|---|
Provider Name | Dr. Sandra Susanne Gebhart |
First Address | Douglas, WY 82633-0688 |
Second Address | Gillette, WY 82718-6406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2013 |
Last Update Date | 24/09/2019 |