Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME 14174 | FL |
NPI | 1215920590 |
---|---|
Provider Name | Dr. Robert H Threlkel |
First Address | Jacksonville, FL 32204-3811 |
Second Address | Jacksonville, FL 32204-3811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D53040 | (02) | FL |