Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | ME82374 | FL |
NPI | 1023089661 |
---|---|
Provider Name | Dr. Henry B Breland |
First Address | Panama City, FL 32405-4501 |
Second Address | Panama City, FL 32405-4501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 21/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
261370100 | (05) | FL |
B42704 | (02) |