Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | LP01941 | RI |
Y | 207P00000X | Emergency Physician | ME118489 | FL |
NPI | 1013237825 |
---|---|
Provider Name | Jordan Gipe Rogers Celeste |
First Address | Maitland, FL 32751-7247 |
Second Address | Maitland, FL 32751-7247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2010 |
Last Update Date | 02/06/2014 |