Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | 10734 | MT |
Y | 207RG0100X | Gastroenterologist | ME22208 | FL |
NPI | 1013975564 |
---|---|
Provider Name | Dr. Elliot Mark Wortzel |
First Address | Plantation, FL 33324 |
Second Address | Plantation, FL 33324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 16/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0351971 | (05) | FL |
D60432 | (02) |