Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN21124 | FL |
NPI | 1164775813 |
---|---|
Provider Name | Dr. Manoel Roberto Macedo |
First Address | Naples, FL 34109 |
Second Address | St Petersburg, FL 33710-1107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2012 |
Last Update Date | 05/06/2017 |