Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN 12419 | FL |
Y | 213EG0000X | General Practice | DN 12419 | FL |
NPI | 1003940669 |
---|---|
Provider Name | Dr. Wade Hampton Townsend III |
First Address | Gainesville, FL 32607-2405 |
Second Address | Gainesville, FL 32607-2405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
66448 | BCBS OF FL PROVIDER # (01) | FL |