Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | ME49905 | FL |
NPI | 1043353303 |
---|---|
Provider Name | Fred Harvey |
First Address | Sarasota, FL 34233-1210 |
Second Address | Sarasota, FL 34233-1210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 24/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BH0142101 | DEA (01) | |
C34583 | (02) |