Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH2440 | FL |
N | 111NN0400X | Neurology | CH2440 | FL |
NPI | 1104806579 |
---|---|
Provider Name | Dr. Randy J. Fearing |
First Address | Gainesville, FL 32606-6570 |
Second Address | Gainesville, FL 32606-6570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 28/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050318500 | (05) | FL |
89904 | BLUE CROSS BLUE SHIELD FL (01) | FL |
T56381 | (02) | FL |