Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | ME89304 | FL |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | ME89304 | FL |
NPI | 1104861319 |
---|---|
Provider Name | Bengt Herweg |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33606-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08405 | BLUE CROSS BLUE SHIELD (01) | FL |
263554200 | (05) | FL |
H08515 | (02) | FL |