Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | OT013773 | PA |
N | 111NI0900X | Internist | OT013773 | PA |
Y | 2086S0102X | Surgical Critical Care | OS13926 | FL |
NPI | 1235450370 |
---|---|
Provider Name | Anthony Gielow |
First Address | Longwood, FL 32750-5166 |
Second Address | Longwood, FL 32750-5166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2010 |
Last Update Date | 30/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018231400 | (05) | FL |