Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME-89551 | FL |
N | 207R00000X | Internist | ME-89551 | FL |
N | 111NI0900X | Internist | ME-89551 | FL |
NPI | 1457321028 |
---|---|
Provider Name | Dr. Juan A Rosario-Collazo |
First Address | Jacksonville, FL 32217-4716 |
Second Address | Jacksonville, FL 32217-4716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 22/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I51616 | (02) | FL |