Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | ME0074132 | FL |
NPI | 1326030966 |
---|---|
Provider Name | Dr. Frank Dominic Cirisano JR. |
First Address | Hallandale, FL 33008-3026 |
Second Address | Delray Beach, FL 33444-8193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 22/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25417260 | (05) | FL |
G29219 | (02) |