Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | SW18238 | FL |
NPI | 1184399339 |
---|---|
Provider Name | Eric James Wengrzyn |
First Address | Lehigh Acres, FL 33976-2507 |
Second Address | Lehigh Acres, FL 33976-2507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2021 |
Last Update Date | 10/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NA | NA (01) |