Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | ME89485 | FL |
NPI | 1114061371 |
---|---|
Provider Name | Joseph Molea |
First Address | Tampa, FL 33607-4164 |
Second Address | Tampa, FL 33607-4164 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 08/07/2007 |