Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 01058318A | IN |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME112703 | FL |
N | 207YS0123X | Facial Plastic Surgeon | 01058318A | IN |
NPI | 1336118017 |
---|---|
Provider Name | Alexander M Gorup |
First Address | Boca Raton, FL 33487-5716 |
Second Address | Boca Raton, FL 33487-5712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 24/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000312445 | ANTHEM PROVIDER NUMBER (01) | IN |
200459890 | (05) | IN |