Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036-121679 | IL |
Y | 111NI0900X | Internist | 036-121679 | IL |
NPI | 1003038423 |
---|---|
Provider Name | Zachariah Gurnsey |
First Address | Springfield, IL 62702-4909 |
Second Address | Springfield, IL 62702-4909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 06/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036121679 | (05) | IL |