Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | MD16892 | OR |
NPI | 1760542724 |
---|---|
Provider Name | Mr. Charles Gerard Hurbis |
First Address | Coos Bay, OR 97420-2134 |
Second Address | Coos Bay, OR 97420-2134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011820 | (05) | OR |
E59368 | (02) | OR |