Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | MA47621 | MA |
NPI | 1780673970 |
---|---|
Provider Name | Dr. Wayne A Gavryck |
First Address | Turners Falls, MA 01376-1816 |
Second Address | Turners Falls, MA 01376-1816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 15/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0138487 | (05) | MA |
A68019 | (02) | MA |