Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | ME0061858 | FL |
NPI | 1952382020 |
---|---|
Provider Name | Andrew Coundouriotis |
First Address | St Petersburg, FL 33714-2126 |
Second Address | St Petersburg, FL 33714-2126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 22/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
370923000 | (05) | FL |
F33595 | (02) | FL |