Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO2997 | FL |
Y | 222Z00000X | Podiatrist | PO2997 | FL |
N | 213EP1101X | Primary Podiatric Medicine | PO2997 | FL |
NPI | 1174545388 |
---|---|
Provider Name | Dr. David S. Collom |
First Address | Safety Harbor, FL 34695-5350 |
Second Address | Safety Harbor, FL 34695-5350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 30/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
65787 | BLUE CROSS BLUE SHIELD (01) | FL |
U89852 | (02) |