Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN3453 | FL |
NPI | 1033222674 |
---|---|
Provider Name | Dr. John Roland Westine |
First Address | Delray Beach, FL 33444-3857 |
Second Address | Delray Beach, FL 33444-3857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
071018 | AVMED INSURANCE (01) | FL |
T55109 | (02) | FL |