Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | ME79942 | FL |
NPI | 1104964253 |
---|---|
Provider Name | Dr. Felipe Collazo-Pagan |
First Address | Orlando, FL 32827-7430 |
Second Address | Orlando, FL 32806-2134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 02/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H34604 | (02) | FL |