Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | M464 | GU |
NPI | 1033264072 |
---|---|
Provider Name | Gabriel P Lombard |
First Address | Chalan Pago, GU 96910-0000 |
Second Address | Tamuning, GU 96913-3153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 07/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000BDXJT | (02) | |
611 | (05) | GU |
BL4324404 | FEDERAL DEA LICENSE US DE (01) | GU |
M464 | GUAM BOARD OF MEDICAL EXAMINERS LICENSURE (01) | GU |