Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO1387 | FL |
Y | 222Z00000X | Podiatrist | PO1387 | FL |
N | 213EP1101X | Primary Podiatric Medicine | PO1387 | FL |
NPI | 1538145974 |
---|---|
Provider Name | Dr. Richard Mark Nettboy |
First Address | Boca Raton, FL 33428-3937 |
Second Address | Boca Raton, FL 33428-3937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 21/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
029636800 | (05) | FL |
T55518 | (02) |