Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH0001688 | FL |
NPI | 1316995764 |
---|---|
Provider Name | Dr. Lawrence Robert Free |
First Address | St Petersburg, FL 33710-7125 |
Second Address | St Petersburg, FL 33710-7125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 12/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050222700 | (05) | FL |
CH1688 | STATE LICENSE NUMBER (01) | FL |
T56118 | (02) | FL |