Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | ME 86370 | FL |
NPI | 1083677322 |
---|---|
Provider Name | Dr. Shaun Isaac |
First Address | St Petersburg, FL 33705-3303 |
Second Address | St Petersburg, FL 33701-4719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 12/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
269689400 | (05) | FL |
I10199 | (02) | FL |