Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN10831 | FL |
NPI | 1114365970 |
---|---|
Provider Name | Agerico M Sayoc |
First Address | Jacksonville, FL 32225-3125 |
Second Address | Jacksonville, FL 32225-3125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2013 |
Last Update Date | 14/06/2013 |