Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME39043 | FL |
NPI | 1194899559 |
---|---|
Provider Name | Dr. Gene Fredric Manko |
First Address | Jupiter, FL 33458-3000 |
Second Address | Jupiter, FL 33458-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |