Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PR528 | FL |
N | 213ES0103X | Foot & Ankle Surgery | PR528 | FL |
NPI | 1588176671 |
---|---|
Provider Name | Dr. Eugene Pastorius JR. |
First Address | Melbourne, FL 32902-1137 |
Second Address | Melbourne, FL 32935-3084 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2017 |
Last Update Date | 13/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PO4151 | MEDICAL LICENSE (01) | FL |