Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | IL |
NPI | 1134145469 |
---|---|
Provider Name | Gershon Yehuda Locker |
First Address | Evanston, IL 60201-1718 |
Second Address | Evanston, IL 60201-1718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D13267 | (02) |