Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME90604 | FL |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME90604 | FL |
NPI | 1346210481 |
---|---|
Provider Name | Jose A. Herrera-Soto |
First Address | Orlando, FL 32806-1215 |
Second Address | Orlando, FL 32806-1215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 10/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
270033600 | (05) | FL |
ME90604 | MEDICAL LICENSE (01) | FL |