Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 16987 | PR |
Y | 208D00000X | General Practice Physician | ACN571 | FL |
NPI | 1013192798 |
---|---|
Provider Name | Alfonso Enrique Martinez-Irizarry |
First Address | Ocala, FL 34471-6528 |
Second Address | Ocala, FL 34471-6528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2007 |
Last Update Date | 18/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016481000 | (05) | FL |