Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | ME41127 | FL |
NPI | 1982640355 |
---|---|
Provider Name | Dr. Albert A Albatrosov |
First Address | Hilo, HI 96720-4770 |
Second Address | Hilo, HI 96720-4770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 23/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D21346 | (02) | FL |