Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME 96240 | FL |
NPI | 1013178169 |
---|---|
Provider Name | Jose Nodarse |
First Address | Boynton Beach, FL 33435-7944 |
Second Address | Boynton Beach, FL 33435-7944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2008 |
Last Update Date | 30/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000898800 | (05) | FL |