Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | ME44076 | FL |
NPI | 1144345695 |
---|---|
Provider Name | Dr. Manuel Antonio Robles |
First Address | Coral Springs, FL 33065-6605 |
Second Address | Coral Springs, FL 33065-6605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
254294300 | (05) | FL |
D63193 | (02) | FL |