Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | ME2690 | FL |
NPI | 1083733067 |
---|---|
Provider Name | John Charles Eustace |
First Address | Miami, FL 33176-2231 |
Second Address | Miami, FL 33176-2231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2007 |
Last Update Date | 08/07/2007 |