Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME63476 | FL |
NPI | 1144290206 |
---|---|
Provider Name | Dr. Philip T Regala |
First Address | Naples, FL 34102-5203 |
Second Address | Naples, FL 34102-5203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 26/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
251729900 | (05) | FL |
32870 | BLUE CROSS (01) | FL |
G55508 | (02) | FL |