Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 09758 | AL |
NPI | 1265482921 |
---|---|
Provider Name | Larry C Kilgore |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C74856 | HEALTHSPRING OF ALABAMA (01) | AL |
C74856 | VIVA (01) | AL |