Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | ME85939 | FL |
Y | 207RX0202X | Medical Oncology | ME85939 | FL |
NPI | 1083605240 |
---|---|
Provider Name | Joseph R Mace |
First Address | Fort Myers, FL 33916-2216 |
Second Address | St Petersburg, FL 33705-1455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 16/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
265260900 | (05) | FL |
47885 | BLUE CROSS / BLUE SHIELD (01) | FL |
G87633 | (02) |