Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 6618 | GA |
Y | 2080P0201X | Pediatric Allergist | ME128352 | FL |
NPI | 1326364811 |
---|---|
Provider Name | Dr. Stephen Dinetz |
First Address | Jacksonville, FL 32256-0532 |
Second Address | Orlando, FL 32827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2010 |
Last Update Date | 17/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018755600 | (05) | FL |