Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 0059983 | FL |
N | 207RH0003X | Hematology & Oncology | 16738 | AL |
NPI | 1023003456 |
---|---|
Provider Name | Alejandro A Inclan |
First Address | Pensacola, FL 32503-2339 |
Second Address | Pensacola, FL 32503-2339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 02/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
053788800 | (05) | FL |
109783 | (05) | AL |
12356 | BCBS (01) | FL |
12356W | MEDICARE (01) | FL |
E90174 | (02) | FL |