Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH8849 | FL |
NPI | 1770663486 |
---|---|
Provider Name | Dr. Timothy M Decanio |
First Address | Royal Palm Beach, FL 33411-1608 |
Second Address | Royal Palm Beach, FL 33411-1608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 28/06/2012 |