Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | ME0049211 | FL |
NPI | 1073540282 |
---|---|
Provider Name | Dr. Lawrence D Kaelin |
First Address | Tallahassee, FL 32308-0588 |
Second Address | Tallahassee, FL 32308-0588 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 31/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00517976A | (05) | GA |
370231600 | (05) | FL |
F27105 | (02) | FL |