Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME74265 | FL |
NPI | 1093721623 |
---|---|
Provider Name | Keith Eric Sommers |
First Address | Tampa, FL 33601-1289 |
Second Address | Tampa, FL 33606-3573 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 09/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
250809500 | (05) | FL |
32184 | BLUE CROSS BLUE SHIELD (01) | FL |
G20864 | (02) | FL |