Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | DS 26123 | PA |
Y | 1223P0300X | Periodontist | DTP 118 | FL |
NPI | 1043276116 |
---|---|
Provider Name | Dr. Herbert Jere Towle III |
First Address | Gainesville, FL 32610-0405 |
Second Address | Gainesville, FL 32610-3003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BT 6276681 | DEA (01) | FL |