Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | ME56897 | FL |
NPI | 1083616254 |
---|---|
Provider Name | Alfred D Harding JR. |
First Address | Jacksonville, FL 32204-4736 |
Second Address | Jacksonville, FL 32204-4736 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 10/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020039804 | MEDICARE RAILROAD (01) | |
062698800 | (05) | FL |
A13006 | (02) | FL |