Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN9260 | FL |
NPI | 1073937355 |
---|---|
Provider Name | Dr. Robert William Ladley |
First Address | Tavares, FL 32778-2402 |
Second Address | Tavares, FL 32778-2402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2014 |
Last Update Date | 07/02/2014 |