Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | ME49727 | FL |
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME49727 | FL |
N | 207NS0135X | Procedural Dermatology | ME49727 | FL |
NPI | 1033101647 |
---|---|
Provider Name | Dr. John L Meisenheimer |
First Address | Orlando, FL 32819-8050 |
Second Address | Orlando, FL 32819-8050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 24/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04058 | BCBS PIN (01) | FL |
D84762 | (02) | FL |