Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | ME68693 | FL |
N | 2080P0201X | Pediatric Allergist | ME68693 | FL |
NPI | 1306870530 |
---|---|
Provider Name | Dana L Broussard Perry |
First Address | Orlando, FL 32835-3128 |
Second Address | Orlando, FL 32835-3128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 09/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
27553 | BLUE CROSS BLUE SHIELD (01) | FL |
5184005 | AETNA (01) | FL |
6608772006 | CIGNA (01) | FL |
G12809 | (02) | FL |