Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME66421 | FL |
N | 111NI0900X | Internist | ME66421 | FL |
Y | 2084N0400X | Neurologist | ME66421 | FL |
NPI | 1043226061 |
---|---|
Provider Name | Dr. Philip Lortz |
First Address | Stuart, FL 34995-2229 |
Second Address | Port St Lucie, FL 34952-5530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 07/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E36897 | (02) | FL |