Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 0012739 | FL |
NPI | 1013930767 |
---|---|
Provider Name | Dr. Theodore R Lerner |
First Address | Boca Raton, FL 33431-7209 |
Second Address | Boca Raton, FL 33431-7209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |