Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | ME116852 | FL |
NPI | 1053676650 |
---|---|
Provider Name | Jason Cheng-En Sea |
First Address | Orlando, FL 32819-8004 |
Second Address | Orlando, FL 32819-8004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2012 |
Last Update Date | 15/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010463700 | (05) | FL |
ME116852 | MEDICAL LICENSE (01) | FL |