Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 925 | OR |
Y | 103T00000X | Psychologist | 925 | OR |
NPI | 1013971167 |
---|---|
Provider Name | Mr. Markham Scott Giblin |
First Address | Corvallis, OR 97330-5916 |
Second Address | Corvallis, OR 97330-5916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R55537 | (02) |