Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | ME24381 | FL |
NPI | 1336134634 |
---|---|
Provider Name | Kent N Leifer |
First Address | Merritt Island, FL 32952-4886 |
Second Address | Merritt Island, FL 32952-4886 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 04/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AETNA 4028111 | AETNA INSURANCE (01) | FL |
D58633 | (02) | FL |