Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 41782 | AL |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | ME74096 | FL |
NPI | 1033189758 |
---|---|
Provider Name | Dr. Mark Manabu Goto |
First Address | Gulf Breeze, FL 32561-4806 |
Second Address | Brewton, AL 36426-1306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 07/04/2021 |