Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME8466 | FL |
Y | 2080P0205X | Pediatric Endocrinologist | ME8466 | FL |
NPI | 1467462358 |
---|---|
Provider Name | Allen W Root |
First Address | Orlando, FL 32891-7770 |
Second Address | St Petersburg, FL 33701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 01/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
053020400 | (05) | FL |
52839 | BLUE CROSS BLUE SHIELD (01) | FL |
D56286 | (02) | FL |