Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 078584 | GA |
N | 207X00000X | Orthopaedic Surgeon | ME 0098607 | FL |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | ME98607 | FL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME98607 | FL |
NPI | 1750336046 |
---|---|
Provider Name | Dr. Dominic S Carreira |
First Address | Atlanta, GA 30309-1476 |
Second Address | Marietta, GA 30068-2764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
278476900 | (05) | FL |
90768 | BCBS (01) | FL |
I38258 | (02) | FL |