Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 19488 | FL |
NPI | 1245264001 |
---|---|
Provider Name | Dr. Stephen Louis Nemerofsky |
First Address | Lantana, FL 33462-4271 |
Second Address | Lantana, FL 33462-4271 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 16/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19488 | MEDICAL LICENSE (01) | FL |