Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | P2261 | FL |
NPI | 1174526081 |
---|---|
Provider Name | Dr. Allan Lowell Green |
First Address | Tamarac, FL 33321-1843 |
Second Address | Tamarac, FL 33321-1843 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 02/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T51169 | (02) | FL |