Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | ME 18390 | FL |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME 18390 | FL |
NPI | 1295922847 |
---|---|
Provider Name | Dr. Elliott C Raby |
First Address | Palatka, FL 32177-4179 |
Second Address | Palatka, FL 32177-4179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2007 |
Last Update Date | 27/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D60148 | (02) | FL |