Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 4 | FL |
NPI | 1205324282 |
---|---|
Provider Name | Kevin S Garrison |
First Address | North Miami Beach, FL 33162-3102 |
Second Address | North Miami Beach, FL 33162-3102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2018 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
028841100 | (05) | FL |