Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN0005796 | FL |
NPI | 1265560148 |
---|---|
Provider Name | Dr. Bernard W Segall |
First Address | Coconut Grove, FL 33133-5417 |
Second Address | Coconut Grove, FL 33133-5417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 25/05/2011 |