Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | ME84538 | FL |
NPI | 1033185392 |
---|---|
Provider Name | Antonio Crespo |
First Address | Orlando, FL 32806-1015 |
Second Address | Orlando, FL 32806-1015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 11/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
265025800 | (05) | FL |
47908 | BCBS (01) | FL |
ME84538 | MEDICAL LICENSE (01) | FL |