Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | ME0070409 | FL |
N | 207XS0117X | Orthopaedic Spine Surgeon | ME0070409 | FL |
NPI | 1144227364 |
---|---|
Provider Name | John M Small |
First Address | Temple Terrace, FL 33637-0925 |
Second Address | Temple Terrace, FL 33637-0925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 13/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200028917 | MEDICARE RAILROAD (01) | FL |
212065 | AVMED (01) | FL |
250385900 | (05) | FL |
31905 | BC/BS (01) | FL |
5054177 | AETNA (01) | FL |
5306966 | CIGNA (01) | FL |
F40082 | (02) | FL |