Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD2019-0672 | NM |
N | 111NI0900X | Internist | MD2019-0672 | NM |
Y | 208000000X | Pediatrician | MD2019-0672 | NM |
NPI | 1003203753 |
---|---|
Provider Name | Zachary L Gitlin |
First Address | Shiprock, NM 87420-0160 |
Second Address | Shiprock, NM 87420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 16/09/2019 |