Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | ME0056675 | FL |
NPI | 1003878653 |
---|---|
Provider Name | Dr. Philip Miles Buttaravoli |
First Address | West Palm Beach, FL 33412-1576 |
Second Address | Vero Beach, FL 32968-4200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 06/07/2009 |