Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME0036591 | FL |
NPI | 1003922592 |
---|---|
Provider Name | Dr. Armand B Cognetta JR. |
First Address | Tallahassee, FL 32317-3859 |
Second Address | Tallahassee, FL 32308-5317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 17/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
37419 | BLUE CROSS BLUE SHIELD (01) | FL |
D83853 | (02) | FL |