Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN18668 | FL |
Y | 213EG0000X | General Practice | DN18668 | FL |
NPI | 1003122656 |
---|---|
Provider Name | Kanyaratana Isaac |
First Address | Panama City, FL 32401-3409 |
Second Address | Panama City, FL 32401-3409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2010 |
Last Update Date | 08/02/2022 |