Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 2015007985 | MO |
Y | 207W00000X | Ophthalmologist | ME127081 | FL |
NPI | 1013203272 |
---|---|
Provider Name | Dr. Bradley Leone Shoss |
First Address | Altamonte Springs, FL 32701-4706 |
Second Address | Altamonte Springs, FL 32701-4706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2011 |
Last Update Date | 05/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018716300 | (05) | FL |