Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME112561 | FL |
NPI | 1235104522 |
---|---|
Provider Name | Jerome Garciano Enad |
First Address | Pensacola, FL 32513-2699 |
Second Address | Port St Joe, FL 32456-5301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 16/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0066090-00 | (05) | FL |
14M8Q | BCBS (01) | FL |