Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 9529 | AL |
NPI | 1033262753 |
---|---|
Provider Name | Gary Roderick Kilgo |
First Address | Northport, AL 35476-0467 |
Second Address | Northport, AL 35476-0467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 22/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C74466 | (02) | AL |