Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME38147 | FL |
NPI | 1003866260 |
---|---|
Provider Name | Dr. David D. Desper JR. |
First Address | St Petersburg, FL 33701-4815 |
Second Address | St Petersburg, FL 33701-4815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 21/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
058776100 | (05) | FL |
D57405 | (02) | |
P00121107 | RAILROAD MEDICARE NUMBER (01) | FL |