Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 12089 | FL |
NPI | 1013981620 |
---|---|
Provider Name | Dr. Tim M Verwest |
First Address | Fort Myers, FL 33919-4939 |
Second Address | Fort Myers, FL 33919-4939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 26/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
073699600 | (05) | FL |
073699601 | (05) | FL |