Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | ME85966 | FL |
Y | 2086S0122X | Plastic and Reconstructive Surgery | ME85966 | FL |
NPI | 1982895223 |
---|---|
Provider Name | Dr. George Dimitrios Papanicolaou |
First Address | Lake Mary, FL 32746-3589 |
Second Address | Lake Mary, FL 32746-3589 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2007 |
Last Update Date | 26/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001633300 | (05) | FL |