Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME56033 | FL |
Y | 208600000X | Surgeon | ME56033 | FL |
NPI | 1013925734 |
---|---|
Provider Name | Dr. Jerzy Tadeusz Polmerski |
First Address | Gainesville, FL 32610-0371 |
Second Address | Lake City, FL 32025-0453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B44615 | (02) |