Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | ME129841 | FL |
NPI | 1063675478 |
---|---|
Provider Name | Juan J Egas |
First Address | Spring Hill, FL 34609-8102 |
Second Address | Lutz, FL 33558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2008 |
Last Update Date | 04/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020516600 | (05) | FL |
NFU5F | BLUE CROSS BLUE SHIELD (01) | FL |