Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0127X | Trauma Surgeon | ME85050 | FL |
NPI | 1487611901 |
---|---|
Provider Name | Dr. Luis Eduardo Llerena |
First Address | Hudson, FL 34667-7180 |
Second Address | Hudson, FL 34667-7180 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 22/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
264771100 | (05) | FL |