Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PO-1411 | FL |
NPI | 1033118187 |
---|---|
Provider Name | Dr. Ian Charles Klein |
First Address | St Petersburg, FL 33702-5201 |
Second Address | St Petersburg, FL 33702-5201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 07/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
057899100 | (05) | FL |
T50965 | (02) | FL |