Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN18971 | FL |
Y | 213EG0000X | General Practice | DN18971 | FL |
N | 1223P0700X | Prosthodontist | DN18971 | FL |
NPI | 1104066448 |
---|---|
Provider Name | Dr. Jose Viana Paiva JR. |
First Address | Panama City, FL 32405-2173 |
Second Address | Panama City, FL 32405-2173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2009 |
Last Update Date | 18/04/2019 |