Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | M-14304 | ID |
N | 2086S0127X | Trauma Surgeon | 40382 | AZ |
N | 2086S0127X | Trauma Surgeon | M5718 | TX |
NPI | 1407862410 |
---|---|
Provider Name | Stephen C Gale |
First Address | Meridian, ID 83642 |
Second Address | Boise, ID 83706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 24/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G90666 | (02) |