Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME39970 | FL |
Y | 208600000X | Surgeon | ME39970 | FL |
NPI | 1023074911 |
---|---|
Provider Name | Alvaro Ramon Bada |
First Address | Port Charlotte, FL 33948 |
Second Address | Port Charlotte, FL 33948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 23/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043820100 | (05) | FL |
D85614 | (02) | FL |