Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME64462 | FL |
N | 2080P0207X | Pediatric Hematology-Oncologist | ME64462 | FL |
NPI | 1093766602 |
---|---|
Provider Name | Clifford Allen Selsky |
First Address | Winter Springs, FL 32708-5246 |
Second Address | Winter Springs, FL 32708-5246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 20/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
373520600 | (05) | FL |
68655 | BCBS (01) | FL |
8300002206 | RAILROAD MEDICARE (01) | |
E89927 | (02) |