Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | ME00033362 | FL |
NPI | 1104849686 |
---|---|
Provider Name | Dr. Luis Raimundo Pagan |
First Address | Hialeah, FL 33016-1897 |
Second Address | Hialeah, FL 33016-1897 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 15/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042852300 | (05) | FL |
D64017 | (02) | FL |