Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 000743 | GA |
NPI | 1265529994 |
---|---|
Provider Name | Dr. Emily Arlene Via |
First Address | Yulee, FL 32097-4793 |
Second Address | Yulee, FL 32097-4793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 25/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00623334B | (05) | GA |
U32143 | (02) | GA |