Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 16183 | AL |
NPI | 1053318030 |
---|---|
Provider Name | Dr. Susan Bonfili Fleet |
First Address | Mobile, AL 36608-1263 |
Second Address | Mobile, AL 36608-1263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 13/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000016183 | (05) | AL |
051535228 | MEDICARE PTAN (01) | AL |
1053318030 | NPI (01) | AL |
C72945 | (02) | AL |