Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | ME69254 | FL |
NPI | 1346242609 |
---|---|
Provider Name | Dr. Luis A Martinez-Frontanilla |
First Address | Clearwater, FL 33757-8744 |
Second Address | Tampa, FL 33607-6307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 16/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
254091600 | (05) | FL |
F20354 | (02) | FL |