Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | CH 3317 | FL |
Y | 213ER0200X | Radiology | CH 3317 | FL |
NPI | 1811083272 |
---|---|
Provider Name | Dr. Terry D Sandman |
First Address | St Petersburg, FL 33707-1833 |
Second Address | St Petersburg, FL 33707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 18/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89803 | BC/BS (01) | FL |
T37267 | (02) | FL |