Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 5101015015 | MI |
NPI | 1306866074 |
---|---|
Provider Name | Grace A Gibbs |
First Address | Lexington, KY 40503-1404 |
Second Address | Lexington, KY 40503-1404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 22/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0700532 | PHP (01) | MI |
1020336 | MHP HAN (01) | MI |
160C311260 | BCBSM CHOICE BCN COM BLUE (01) | MI |
4865240 | (05) | MI |
7100349070 | (05) | KY |