Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME25170 | FL |
Y | 208600000X | Surgeon | ME25170 | FL |
NPI | 1023030749 |
---|---|
Provider Name | Carlos Maldonado |
First Address | Stuart, FL 34995-0417 |
Second Address | Stuart, FL 34996-3310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 30/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
055743900 | (05) | FL |
D54838 | (02) | FL |