Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME36928 | FL |
Y | 207XS0117X | Orthopaedic Spine Surgeon | ME36928 | FL |
NPI | 1003964222 |
---|---|
Provider Name | Dr. Donald Henry Vliegenthart |
First Address | Melbourne, FL 32901-1936 |
Second Address | Melbourne, FL 32901-1936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 16/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26612 | BCBS OF FL (01) | FL |
BB109Y | (02) | FL |