Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME25671 | FL |
Y | 2080N0001X | Neonatal-Perinatal Doctor | ME25671 | FL |
NPI | 1043279169 |
---|---|
Provider Name | Dr. Thomas Tak Chiu |
First Address | Jacksonville, FL 32231-4008 |
Second Address | Jacksonville, FL 32209-6511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2006 |
Last Update Date | 06/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000207116B | (05) | GA |
0571385-00 | (05) | FL |
D85111 | (02) | FL |