Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ME102682 | FL |
NPI | 1023207016 |
---|---|
Provider Name | James R Meredith |
First Address | Apopka, FL 32712-4152 |
Second Address | New Smyrna Beach, FL 32168-7325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2007 |
Last Update Date | 25/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G0576Z | (02) | FL |