Individual
IRIS LEVON GATHERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERTIFIED HAIR LOSS
Contact information
Practice address
200 REID AVE, PORT ST JOE, FL 32456-1824
(850) 229-4247
Mailing address
PO BOX 1142, PORT ST JOE, FL 32457-1142
(850) 227-6029
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
L1709270000753
FL
Other
Enumeration date
05/02/2018
Last updated
05/02/2018
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