Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E3547 | CA |
Y | 222Z00000X | Podiatrist | E3547 | CA |
NPI | 1013095702 |
---|---|
Provider Name | Gregg A. Gilles |
First Address | Oakland, CA 94612-3429 |
Second Address | Sacramento, CA 95825-2115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E35470 | (05) | CA |
U27666 | (02) |