Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 65080 | CA |
Y | 213EG0000X | General Practice | 65080 | CA |
NPI | 1003285453 |
---|---|
Provider Name | Anthony James Marin |
First Address | Jacksonville, FL 32212-0140 |
Second Address | Jacksonville, FL 32212-0140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2015 |
Last Update Date | 16/09/2015 |