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General NPI Number Information
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NPI Number | 1073708111
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Entity Type | Organization
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Legal Business Name | KENNETH L. GAYLES, M.D., P.C.
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Dates
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Enumeration Date | 09/12/2007
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 840 HUMBOLDT PKWY
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City | BUFFALO
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State | NY
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Zip | 14211-1217
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Country | US
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Telephone | 716-895-1100
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Fax | 716-895-8460
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Provider Business Mailing Address
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Address Line | 840 HUMBOLDT PKWY
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City | BUFFALO
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State | NY
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Zip | 14211-1217
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Country | US
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Telephone | 716-895-1100
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Fax | 716-895-8460
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH L GAYLES
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Credential |
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Telephone | 716-895-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 124683
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License Number State | NY
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