Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME0066760 | FL |
N | 207NS0135X | Procedural Dermatology | ME0066760 | FL |
NPI | 1356343115 |
---|---|
Provider Name | Dr. Terrence Allan Cronin JR. |
First Address | Melbourne, FL 32901-3208 |
Second Address | Melbourne, FL 32901-3208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 08/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070007155 | RAILROAD MEDICARE (01) | FL |
18258 | AETNA (01) | FL |
26265 | FLORIDA BLUE SHIELD (01) | FL |
26265 | MEDICARE (01) | FL |
379600100 | (05) | FL |
6189190 | CIGNA (01) | |
F91657 | (02) |