Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME108696 | FL |
NPI | 1023213634 |
---|---|
Provider Name | Dr. William Harris Green |
First Address | Tallahassee, FL 32317-3859 |
Second Address | Tallahassee, FL 32308-5317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 13/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14AN7 | BLUE CROSS BLUE SHIELD OF FLORIDA (01) | FL |