Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | ME18441 | FL |
Y | 208D00000X | General Practice Physician | ME18441 | FL |
NPI | 1285970160 |
---|---|
Provider Name | Dr. Douglas Mclean Roy I |
First Address | Winter Haven, FL 33884-3039 |
Second Address | Winter Haven, FL 33884-3039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2012 |
Last Update Date | 20/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ME18441 | FL. LICENSE (01) | FL |