Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | OS15148 | FL |
NPI | 1316326515 |
---|---|
Provider Name | Aleksey Alekseyenko |
First Address | Port St Lucie, FL 34987 |
Second Address | Port St Lucie, FL 34987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2015 |
Last Update Date | 14/10/2020 |