Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 01078652A | IN |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 036142424 | IL |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD2018-0629 | NM |
NPI | 1740546563 |
---|---|
Provider Name | Katherine J Gavin |
First Address | Albuquerque, NM 87106-4375 |
Second Address | Albuquerque, NM 87131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2012 |
Last Update Date | 13/08/2018 |