Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | ME 83195 | FL |
NPI | 1063413276 |
---|---|
Provider Name | Ms. Cynthia Lou Gaboury |
First Address | Tallahassee, FL 32308-4620 |
Second Address | Tallahassee, FL 32308-4620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 26/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
262448600 | (05) | FL |
E60601 | (02) |