Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 79407 | GA |
NPI | 1922263284 |
---|---|
Provider Name | Gilbert Chan |
First Address | Atlanta, GA 30329-2224 |
Second Address | Atlanta, GA 30329-2224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2008 |
Last Update Date | 06/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201033400 | (05) | IN |
7100172640 | (05) | KY |