Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | MD067807L | PA |
NPI | 1548256969 |
---|---|
Provider Name | Dr. Scott Matthew Gayner |
First Address | Harrisburg, PA 17110 |
Second Address | Harrisburg, PA 17110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 24/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F84539 | (02) | PA |