Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | OS10783 | FL |
NPI | 1023260205 |
---|---|
Provider Name | Dr. Michael Warren Fountain |
First Address | Tavares, FL 32778-5229 |
Second Address | Tavares, FL 32778-5229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2008 |
Last Update Date | 09/09/2015 |