Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO2742 | FL |
Y | 222Z00000X | Podiatrist | PO2742 | FL |
NPI | 1053389445 |
---|---|
Provider Name | Jorge L Dopico |
First Address | Winter Haven, FL 33881-4129 |
Second Address | Winter Haven, FL 33881-4129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 20/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
390454700 | (05) | FL |
480027080 | MEDICARE ID/RRM PIN (01) | FL |
U60299 | (02) | FL |