Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME 88175 | FL |
NPI | 1144215823 |
---|---|
Provider Name | Diedre T Cagle |
First Address | Brooksville, FL 34613-6072 |
Second Address | Weeki Wachee, FL 34607-2501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2005 |
Last Update Date | 08/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
271034000 | (05) | FL |
37307 | BCBS (01) | FL |
B59391 | (02) | |
P01125564 | RR MCR (01) | FL |
U1375S | MEDICARE TYPE - UNSPECIFIED (01) | FL |