Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | 35065372 | OH |
Y | 207VG0400X | Gynecologist | ME125455 | FL |
N | 208800000X | Urologist | 35-065372 | OH |
NPI | 1033197504 |
---|---|
Provider Name | John B. Devine II |
First Address | Venice, FL 34292-1623 |
Second Address | Venice, FL 34292-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 23/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016370600 | (05) | FL |
4259931 | MEDICARE ID (01) | OH |
F65285 | (02) | |
JO0875011 | MEDICARE ID (01) | OH |