Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 17214 | FL |
NPI | 1558358382 |
---|---|
Provider Name | Dr. Jerry Alan Margolin |
First Address | Palm Harbor, FL 34683-7212 |
Second Address | Clearwater, FL 33756-5945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D58111 | (02) |