Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME46341 | FL |
N | 207ND0101X | MOHS-Micrographic Surgeon | 46341 | FL |
NPI | 1114039732 |
---|---|
Provider Name | Dr. Susan St.clair Roper |
First Address | Clearwater, FL 33763-1724 |
Second Address | Clearwater, FL 33763-1724 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 13/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114039732 | NPI (01) | |
79962 | BLUE CROSS/BLUE SHIELD (01) | FL |
K1008 | PTAN (01) |