Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | ME135320 | FL |
NPI | 1255697298 |
---|---|
Provider Name | Joshua B Elston |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2012 |
Last Update Date | 23/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
025183800 | (05) | FL |
H99LH | BLUE CROSS BLUE SHIELD (01) | FL |