Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036107556 | IL |
N | 207XS0117X | Orthopaedic Spine Surgeon | 036107556 | IL |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 35.072606 | OH |
NPI | 1376506824 |
---|---|
Provider Name | Josue Peretra Gabriel |
First Address | Hilliard, OH 43026-7568 |
Second Address | Hilliard, OH 43026-7568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G95293 | (02) |