Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | ME67989 | FL |
NPI | 1982693404 |
---|---|
Provider Name | Anita Chen |
First Address | Jacksonville, FL 32224-1865 |
Second Address | Jacksonville, FL 32224-1865 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 31/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G15137 | (02) | FL |