Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 112976 | FL |
NPI | 1013160126 |
---|---|
Provider Name | Frederick Emerson Hasty IV |
First Address | Hollywood, FL 33081-0759 |
Second Address | Miami Beach, FL 33140-2948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2008 |
Last Update Date | 11/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005548600 | (05) | FL |
84926 | FLORIDA BLUE (01) | FL |