Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 01030790A | IN |
NPI | 1043339005 |
---|---|
Provider Name | Joseph Nelson Gaddy |
First Address | Plainfield, IN 46168-8308 |
Second Address | Indianapolis, IN 46219-1787 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B52949 | (02) | IN |