Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 01019128A | IN |
Y | 207YS0123X | Facial Plastic Surgeon | 336.009854 | IL |
NPI | 1811305568 |
---|---|
Provider Name | Dr. Medney Tardy JR. |
First Address | Naples, FL 34105-7400 |
Second Address | Naples, FL 34105-7400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2014 |
Last Update Date | 25/07/2014 |