Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME71870 | FL |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME71870 | FL |
NPI | 1184789893 |
---|---|
Provider Name | Dr. Berge Marcarian |
First Address | Lake City, FL 32056-1359 |
Second Address | Lake City, FL 32055-4879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 17/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G43814 | (02) | FL |