Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | OS07265 | FL |
NPI | 1003815895 |
---|---|
Provider Name | Kelly M. Vangilder |
First Address | West Palm Beach, FL 33407 |
Second Address | Jupiter, FL 33458-7100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 25/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
251951800 | (05) | FL |
G73898 | (02) | FL |
P00192860 | RAILROAD MEDICARE (01) | FL |