Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 4801 | FL |
Y | 111NI0900X | Internist | 4801 | FL |
N | 111NN1001X | Nutrition | 4801 | FL |
NPI | 1114030400 |
---|---|
Provider Name | Dr. John Andrew Podlaski |
First Address | Ocala, FL 34471-0710 |
Second Address | Ocala, FL 34471-0710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 21/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55690 | BCBS (01) | FL |
BG080Z | MEDICARE (01) | FL |