Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | ME87618 | FL |
NPI | 1053375584 |
---|---|
Provider Name | Juan Premoli |
First Address | Fort Myers, FL 33907-1412 |
Second Address | Aventura, FL 33180-1226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 10/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
240750 | WELLCARE (01) | FL |
275037600 | (05) | FL |
7845484 | AETNA PROVIDER # (01) | FL |
81710 | BCBS FL (01) | FL |
H97726 | (02) | FL |
P0003165 | FLORIDA HEALTHCARE PLUS (01) | FL |
P00721043 | RR MEDICARE PTAN (01) | FL |
P01720865 | SIMPLY HEALTHCARE (01) | FL |
QMP000003854191 | MOLINA (01) | FL |