Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | POR40 | FL |
N | 222Z00000X | Podiatrist | POR40 | FL |
Y | 224P00000X | Prosthetist | POR40 | FL |
NPI | 1366983405 |
---|---|
Provider Name | Brett Richard Saunders |
First Address | Lady Lake, FL 32159-6340 |
Second Address | Lady Lake, FL 32159-6340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2017 |
Last Update Date | 08/03/2017 |