Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 11432 | FL |
Y | 207T00000X | Neurosurgeon | ME108649 | FL |
NPI | 1104016252 |
---|---|
Provider Name | Dr. Justin Matthew Sporrer |
First Address | Miami, FL 33176-2144 |
Second Address | Miami, FL 33176-2144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 08/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008991600 | (05) | FL |