Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN17080 | FL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DN17080 | FL |
NPI | 1194983965 |
---|---|
Provider Name | Dr. Eric Richard Claussen |
First Address | Panama City, FL 32405-4311 |
Second Address | Panama City, FL 32405-4311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2008 |
Last Update Date | 05/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003224200 | (05) | FL |
ES851B | (02) | FL |