Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO 1874 | FL |
Y | 222Z00000X | Podiatrist | PO 1874 | FL |
NPI | 1003904467 |
---|---|
Provider Name | Dr. Joseph E Kiefer |
First Address | Pensacola, FL 32503-4535 |
Second Address | Pensacola, FL 32503-4535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 10/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
593567914 | TAX ID (01) | FL |
65020 | BLUE CROSS BLUE SHIELD (01) | FL |
T94329 | (02) | FL |