Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 1612 | TX |
Y | 213EP1101X | Primary Podiatric Medicine | PO3432 | FL |
NPI | 1326132374 |
---|---|
Provider Name | Dr. Matthew C Hakeman |
First Address | Orlando, FL 32819-4720 |
Second Address | Orlando, FL 32819-4720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 17/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U92245 | (02) | TX |