Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 01020791A | IN |
NPI | 1194706150 |
---|---|
Provider Name | Joseph D Gifford |
First Address | Toledo, OH 43614-1509 |
Second Address | Peru, IN 46970-1638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 31/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100084220B | (05) | IN |
220004842 | RAILROAD (01) | |
E06518 | (02) | IN |