Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME0036163 | FL |
N | 207ND0101X | MOHS-Micrographic Surgeon | ME0036163 | FL |
N | 207ND0900X | Dermatopathologist | ME0036163 | FL |
N | 207NS0135X | Procedural Dermatology | ME0036163 | FL |
NPI | 1043218860 |
---|---|
Provider Name | Dr. Frederick R Behringer JR. |
First Address | Lutz, FL 33558-4880 |
Second Address | Ocala, FL 34471-5587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 26/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101811900 | (05) | FL |
D85731 | (02) | FL |