Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME78077 | FL |
NPI | 1003893678 |
---|---|
Provider Name | Christopher Emanuel |
First Address | Salt Lake City, UT 84110-0959 |
Second Address | Jacksonville, FL 32217-4612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 11/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H07172 | (02) |