Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | LL672 | FL |
NPI | 1134379365 |
---|---|
Provider Name | David B. Macmillan |
First Address | Venice, FL 34293-1510 |
Second Address | Venice, FL 34293-1510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2008 |
Last Update Date | 15/08/2019 |