Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 58487 | FL |
NPI | 1194874560 |
---|---|
Provider Name | Dr. Chester Joseph Janecki |
First Address | Largo, FL 33777-1303 |
Second Address | Tampa, FL 33607-6229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C49612 | (02) | FL |