Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 26447 | OK |
Y | 207QS0010X | Family Doctor - Sports Medicine | ME123994 | FL |
NPI | 1295998037 |
---|---|
Provider Name | Dr. Martin Rojas Canillas |
First Address | Spring Hill, FL 34609-8102 |
Second Address | Brooksville, FL 34613-6003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015444400 | (05) | FL |
1213R | BLUE CROSS BLUE SHIELD (01) | FL |