Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | ME112162 | FL |
N | 207XS0106X | Orthopaedic Hand Surgeon | ME112162 | FL |
NPI | 1285851907 |
---|---|
Provider Name | Dr. Mark Ngu Awantang |
First Address | Panama City, FL 32405-7605 |
Second Address | Panama City, FL 32405-7605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 27/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GB345Z | (02) |