Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 08944 | MS |
NPI | 1073533030 |
---|---|
Provider Name | Herbert Giles |
First Address | Gulfport, MS 39503-7911 |
Second Address | Biloxi, MS 39531-2410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |