Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | ME148414 | FL |
NPI | 1932561313 |
---|---|
Provider Name | Harrison Bartels |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33612-6601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2016 |
Last Update Date | 03/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111509300 | (05) | FL |
JGSXB | BCBS (01) | FL |