Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME96989 | FL |
N | 207QS0010X | Family Doctor - Sports Medicine | ME96989 | FL |
NPI | 1205900388 |
---|---|
Provider Name | Beth Lloyd |
First Address | Venice, FL 34284-1157 |
Second Address | Sarasota, FL 34236-4241 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 13/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G39872 | (02) |