Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ME129646 | FL |
N | 208600000X | Surgeon | ME129646 | FL |
Y | 2086X0206X | Surgical Oncologist | ME129646 | FL |
NPI | 1326123662 |
---|---|
Provider Name | Christopher Mario Pezzi |
First Address | Jacksonville, FL 32232-5278 |
Second Address | Jacksonville, FL 32207-8432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 02/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019497400 | (05) | FL |
C20476 | (02) | PA |
P01775071 | RR MEDICARE (01) | FL |