Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | ME111542 | FL |
NPI | 1003863135 |
---|---|
Provider Name | Dr. Augustine Enyinna Agocha |
First Address | Tampa, FL 33613-4696 |
Second Address | Tampa, FL 33613-4696 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 22/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004434500 | (05) | FL |
315723 | (05) | SC |
7716800 | (05) | NJ |
G8072 | (02) | |
G80972 | (02) | NJ |