Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | ME24616 | FL |
NPI | 1013925684 |
---|---|
Provider Name | Adam Wanner |
First Address | Miami, FL 33136-1028 |
Second Address | Miami, FL 33136-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 31/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3718514-00 | (05) | FL |
91540 | (02) | FL |
D59698 | (02) |