Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | 02004699A | IN |
N | 207VX0201X | Gynecologic Oncologist | 34.005939F | OH |
Y | 207VX0201X | Gynecologic Oncologist | OS15508 | FL |
N | 207VX0201X | Gynecologic Oncologist | TL36735 | SC |
NPI | 1366419418 |
---|---|
Provider Name | James Fanning |
First Address | Tampa, FL 33622-5317 |
Second Address | Tampa, FL 33607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 10/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0974941 | (05) | OH |
E64560 | (02) |