Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | ME123792 | FL |
NPI | 1205074002 |
---|---|
Provider Name | Dr. Jason Jeong Hwan Song |
First Address | Saint Cloud, FL 34769-4939 |
Second Address | Saint Cloud, FL 34769-4939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2009 |
Last Update Date | 30/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015031800 | (05) | FL |