Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | ME48419 | FL |
NPI | 1003923327 |
---|---|
Provider Name | Geoffrey Boyajian |
First Address | St Petersburg, FL 33742-2005 |
Second Address | St Petersburg, FL 33716-1860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 21/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
050080215 | RR MEDICARE (01) | FL |
370636200 | (05) | FL |
96992 | BCBS (01) | FL |
D64059 | (02) |