Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | ME79256 | FL |
NPI | 1023070539 |
---|---|
Provider Name | Dr. Michael Craig Solomon |
First Address | Port St Lucie, FL 34986-1623 |
Second Address | Port St Lucie, FL 34986-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 25/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
265785600 | (05) | FL |
GT524A | (02) | FL |
H26899 | (02) | FL |