Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | ME120465 | FL |
NPI | 1134419310 |
---|---|
Provider Name | Emma Westermann-Clark |
First Address | Orlando, FL 32891-0001 |
Second Address | St Petersburg, FL 33701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2011 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014511700 | (05) | FL |
14X80 | BLUE CROSS BLUE SHIELD (01) | FL |