Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | ME0049689 | FL |
N | 207RS0012X | Sleep Medicine | ME49689 | FL |
NPI | 1013082635 |
---|---|
Provider Name | Jonathan P Axel |
First Address | Brandon, FL 33511-5911 |
Second Address | Brandon, FL 33511-5911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 01/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
062532900 | (05) | FL |
E60247 | (02) | FL |