Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | MC005560NJ | NJ |
Y | 111NN0400X | Neurology | CH9887 | FL |
NPI | 1982701520 |
---|---|
Provider Name | Dr. Anthony Serle |
First Address | Jacksonville, FL 32256-4849 |
Second Address | Jacksonville, FL 32256-4849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 07/10/2013 |