Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 02004142A | IN |
NPI | 1275735581 |
---|---|
Provider Name | John S Gilbert |
First Address | South Bend, IN 46617-1924 |
Second Address | Elkhart, IN 46514-1927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201134970 | (05) | IN |