Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 4301081978 | MI |
NPI | 1003825894 |
---|---|
Provider Name | Rubin Peter Gappy |
First Address | Macomb, MI 48044-5742 |
Second Address | Saint Clair Shores, MI 48080-1775 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4301081978 | PHYS LICENSE (01) | MI |
5315028539 | CONT SUB LICENSE (01) | MI |