Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME124263 | FL |
N | 207QS0010X | Family Doctor - Sports Medicine | ME 124263 | FL |
NPI | 1245434299 |
---|---|
Provider Name | Dr. Nathan P Falk |
First Address | Clearwater, FL 33759-3012 |
Second Address | Winter Haven, FL 33880-3904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 05/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016940700 | (05) | FL |