Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | M-10752 | ID |
NPI | 1003073560 |
---|---|
Provider Name | Dr. Joe Marie Franz Llenos |
First Address | Atlanta, GA 30384-7976 |
Second Address | Caldwell, ID 83605-5432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
808443000 | (05) | ID |