Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 13121 | AZ |
NPI | 1194820761 |
---|---|
Provider Name | J David Gibeault |
First Address | Tucson, AZ 85751-0370 |
Second Address | Tucson, AZ 85719-2315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 22/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
249202 | (05) | AZ |
C99540 | (02) | AZ |