Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME 105585 | FL |
N | 208D00000X | General Practice Physician | ME105585 | FL |
NPI | 1033446349 |
---|---|
Provider Name | Dr. Liron Beltzer |
First Address | Miami Shores, FL 33138-2603 |
Second Address | Miramar, FL 33027-6308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2009 |
Last Update Date | 28/06/2011 |