Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | ME108820 | FL |
NPI | 1043316227 |
---|---|
Provider Name | Grace A Freire |
First Address | St Petersburg, FL 33701-4804 |
Second Address | Saint Petersburg, FL 33701-4804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 25/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003016500 | (05) | FL |
ME108820 | FLORIDA MEDICAL LICENSE (01) | FL |