Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME91466 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | ME91466 | FL |
NPI | 1770578916 |
---|---|
Provider Name | Dr. Eric M Folkens |
First Address | Bradenton, FL 34209-3441 |
Second Address | Bradenton, FL 34210-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 28/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
273745100 | (05) | FL |
I29146 | (02) |