Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 9532 | FL |
NPI | 1053483537 |
---|---|
Provider Name | Dr. James A. Aurelio |
First Address | Gainesville, FL 32608-7985 |
Second Address | Port Charlotte, FL 33952-8134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9532 | DENTAL LICENSE (01) | FL |