Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | ME 76595 | FL |
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME76595 | FL |
NPI | 1417947961 |
---|---|
Provider Name | Dr. Leonard A Shvartzman |
First Address | Jacksonville, FL 32204-4161 |
Second Address | Jacksonville, FL 32204-4161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 01/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G77179 | (02) | FL |