Provider Demographics
NPI:1528198413
Name:GILMORE, SARA MELISSA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MELISSA
Last Name:GILMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1892
Mailing Address - Street 2:119 ALATNA ST #4
Mailing Address - City:VALDEZ
Mailing Address - State:AK
Mailing Address - Zip Code:99686
Mailing Address - Country:US
Mailing Address - Phone:907-835-8608
Mailing Address - Fax:
Practice Address - Street 1:128 SCENEGA
Practice Address - Street 2:
Practice Address - City:VALDEZ
Practice Address - State:AK
Practice Address - Zip Code:99686
Practice Address - Country:US
Practice Address - Phone:907-835-3274
Practice Address - Fax:907-835-3512
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
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