Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | ME115192 | FL |
N | 2080P0203X | Pediatric Critical Care Doctor | N3994 | TX |
NPI | 1215201751 |
---|---|
Provider Name | Joseph Philip |
First Address | Orlando, FL 32891-0001 |
Second Address | Gainesville, FL 32610-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2012 |
Last Update Date | 15/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009073900 | (05) | FL |