Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 1003278433 | FL |
NPI | 1003278433 |
---|---|
Provider Name | Landon Lichtman |
First Address | Orlando, FL 32803-1248 |
Second Address | Orlando, FL 32803-1248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2016 |
Last Update Date | 03/05/2019 |