Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO-0002391 | FL |
NPI | 1588753040 |
---|---|
Provider Name | Dmitry Sandler |
First Address | North Miami Beach, FL 33162-4115 |
Second Address | North Miami Beach, FL 33162-4115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 14/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
270007700 | (05) | FL |
U92045 | (02) | FL |