Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN17270 | FL |
N | 204E00000X | Oral & Maxillofacial Surgeon | DN17270 | FL |
N | 204E00000X | Oral & Maxillofacial Surgeon | DS030473L | PA |
NPI | 1124000575 |
---|---|
Provider Name | John Robert Pasqual |
First Address | Delray Beach, FL 33445-6600 |
Second Address | Delray Beach, FL 33445-6600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 17/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1011842730001 | (05) | PA |