Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | ME115842 | FL |
NPI | 1386851350 |
---|---|
Provider Name | Dr. Anthony Nosa Imudia |
First Address | Tampa, FL 33622-5317 |
Second Address | Wesley Chapel, FL 33544-6787 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 04/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009039400 | (05) | FL |
14R2J | BLUE CROSS BLUE SHIELD (01) | FL |