Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 34.009567 | OH |
NPI | 1013151729 |
---|---|
Provider Name | Dr. Thomas Daniel Gifford |
First Address | Warren, OH 44484-4503 |
Second Address | Warren, OH 44484-4503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2009 |
Last Update Date | 30/04/2009 |