Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME70118 | FL |
NPI | 1225009160 |
---|---|
Provider Name | Laura M.w. Meyer |
First Address | Clearwater, FL 33756 |
Second Address | Clearwater, FL 33756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ME70118 | MEDICAL LICENSE (01) | FL |