Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207NS0135X | Procedural Dermatology | 61005 | GA |
Y | 207Q00000X | Family Doctor | 61005 | GA |
NPI | 1447494885 |
---|---|
Provider Name | Dr. Matteo Taerri |
First Address | Sarasota, FL 34236-5050 |
Second Address | Sarasota, FL 34236-5050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2009 |
Last Update Date | 29/04/2009 |