Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | ME78248 | FL |
Y | 207YS0123X | Facial Plastic Surgeon | ME78248 | FL |
NPI | 1780684399 |
---|---|
Provider Name | Dino Madonna |
First Address | Leesburg, FL 34748-5953 |
Second Address | Leesburg, FL 34748-5953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 16/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
256975200 | (05) | FL |
G74176 | (02) | FL |