Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME71061 | FL |
NPI | 1053388728 |
---|---|
Provider Name | James T Go |
First Address | Melbourne, FL 32935-3165 |
Second Address | Melbourne, FL 32935-3133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 19/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040014966 | RAIL ROAD MEDICARE (01) | |
251059600 | (05) | FL |
G29305 | (02) |