Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 2016-00916 | NC |
NPI | 1033471768 |
---|---|
Provider Name | Gabriela Rodriguez De Boer |
First Address | Hickory, NC 28603-3445 |
Second Address | Hickory, NC 28602-4031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2012 |
Last Update Date | 15/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033471768 | (05) | NC |
1853558 | WELLCARE (01) | NC |
19LIP | BCBS (01) | NC |
4188317 | AETNA (01) | NC |
4188317 | ENVOLVE (01) | NC |
A28835 | EYEMED (01) | NC |