Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CH0007521 | FL |
NPI | 1053306563 |
---|---|
Provider Name | Dr. Robert Devincentis |
First Address | Jacksonville, FL 32250-1545 |
Second Address | Jacksonville, FL 32250-1545 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 23/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
381167100 | (05) | FL |
U72939 | (02) | FL |