Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | ME74735 | FL |
NPI | 1063434413 |
---|---|
Provider Name | Dr. John T Chacko |
First Address | Ocala, FL 34471-8170 |
Second Address | Marianna, FL 32446-1933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 09/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
42842 | BCBSFL (01) | FL |
G68521 | (02) | FL |