Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 21056 | PR |
Y | 208D00000X | General Practice Physician | ACN1219 | FL |
NPI | 1003302290 |
---|---|
Provider Name | Dr. Martin Francisco Aguero |
First Address | Port Charlotte, FL 33954-2807 |
Second Address | Port Charlotte, FL 33954-1037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2018 |
Last Update Date | 15/10/2020 |