Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 189632 | NY |
NPI | 1063418176 |
---|---|
Provider Name | John Gibbs |
First Address | Buffalo, NY 14263-0001 |
Second Address | Buffalo, NY 14263-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 11/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01706385 | (05) | NY |
E36979 | (02) | NY |