Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS 8272 | FL |
NPI | 1427189448 |
---|---|
Provider Name | Dr. Trevor Thomas Nimmons |
First Address | Indialantic, FL 32903-3118 |
Second Address | Melbourne, FL 32935-4909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I 43858 | (02) | FL |