Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO2175 | FL |
Y | 222Z00000X | Podiatrist | PO2175 | FL |
NPI | 1003879305 |
---|---|
Provider Name | Dr. Edwin Pratts |
First Address | Miramar, FL 33029 |
Second Address | Miami, FL 33135-1439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 24/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
058273500 | (05) | FL |
U27931 | (02) | FL |