Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO2872 | FL |
NPI | 1013919802 |
---|---|
Provider Name | Dr. Craig Sapenoff |
First Address | West Palm Beach, FL 33417-4624 |
Second Address | West Palm Beach, FL 33417-4624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 02/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340309200 | (05) | FL |
U80240 | (02) | FL |