Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME0090103 | FL |
NPI | 1003899212 |
---|---|
Provider Name | Jose A Lavergne |
First Address | North Miami Beach, FL 33162-1744 |
Second Address | North Miami Beach, FL 33162-1744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 23/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
271347100 | (05) | FL |
F78244 | (02) |