Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | DO00442 | RI |
Y | 207RG0100X | Gastroenterologist | DO15999 | FL |
NPI | 1023014735 |
---|---|
Provider Name | Dr. Raymond J Mis |
First Address | The Villages, FL 32162-2699 |
Second Address | The Villages, FL 32159-8987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 27/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9003105 | (05) | RI |
F83941 | (02) |