Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 18122 | AL |
NPI | 1083669444 |
---|---|
Provider Name | Dr. Richard Lewis Palesano |
First Address | Mobile, AL 36606-2457 |
Second Address | Mobile, AL 36606-2457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 07/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E67016 | (02) |