Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | ME93733 | FL |
NPI | 1639289507 |
---|---|
Provider Name | Dr. Cedric J Tankson |
First Address | Leesburg, FL 34748-7313 |
Second Address | Leesburg, FL 34748-7313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 02/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30061 | BLUE CROSS OF FL (01) | FL |
I39507 | (02) | FL |