Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | MD09174 | RI |
NPI | 1801904958 |
---|---|
Provider Name | Sharon E Gibson |
First Address | Providence, RI 02905-2403 |
Second Address | Providence, RI 02906-2010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 05/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9020307 | (05) | RI |
F54303 | (02) | RI |