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NPI Profile for FRED GAMMON in RIVERTON, KS.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Addiction (Substance Use Disorder) |
101YA0400X |
| NPI # | 1699192617 |
|
| Status | Active | |
| Credentials | T-LAC | |
| Entity | Individual | |
| Enumeration date | 03/27/2014 | |
| Last updated | 03/27/2014 - About 12 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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FRED GAMMON
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FRED GAMMON, T-LAC