Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | ME86630 | FL |
NPI | 1083634950 |
---|---|
Provider Name | Larry Kvols |
First Address | Orlando, FL 32891-7770 |
Second Address | Tampa, FL 33612-9416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 21/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
46978 | BLUE CROSS BLUE SHIELD (01) | FL |
D81596 | (02) | FL |