Individual
KATHRYN BOYSE GANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
258 GIBSON DR, STE 140, ROSEVILLE, CA 95678-5881
(916) 755-0077
(916) 755-0099
Mailing address
258 GIBSON DR, STE 140, ROSEVILLE, CA 95678-5881
(916) 755-0077
(916) 755-0099
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
123615
CA
207N00000X
Dermatology Physician
35.090979
OH
207N00000X
Dermatology Physician
57.012401
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000610931
ANTHEM BC/BS
OH
01
—
P00824293
RAILROAD MEDICARE
OH
Enumeration date
04/17/2007
Last updated
08/10/2018
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