Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | ME135258 | FL |
NPI | 1154749893 |
---|---|
Provider Name | Dr. Sasha Gourgue |
First Address | Jacksonville, FL 32209-6511 |
Second Address | Jacksonville, FL 32209-6511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 26/06/2020 |