Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO2977 | FL |
NPI | 1053330589 |
---|---|
Provider Name | Dr. Michele Mcgowan |
First Address | Clermont, FL 34711-6886 |
Second Address | Clermont, FL 34711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 19/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043604213 | CIGNA (01) | FL |
043604213 | TRICARE (01) | FL |
340295900 | (05) | FL |
4690780001 | PALMETTO GBA (01) | FL |
65755 | BC/BS (01) | FL |
U91560 | (02) | FL |