Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME59480 | FL |
N | 207ND0101X | MOHS-Micrographic Surgeon | ME59480 | FL |
N | 207ND0900X | Dermatopathologist | ME59480 | FL |
N | 207NS0135X | Procedural Dermatology | ME59480 | FL |
NPI | 1699764993 |
---|---|
Provider Name | Dr. Kenneth Beer |
First Address | West Palm Beach, FL 33401-2712 |
Second Address | West Palm Beach, FL 33401-2712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 27/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F11057 | (02) | FL |