Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | ME102964 | FL |
NPI | 1003045170 |
---|---|
Provider Name | Efrem D Mandelcorn |
First Address | Miami, FL 33136-1119 |
Second Address | Miami, FL 33136-1119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2009 |
Last Update Date | 09/07/2009 |