Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 80160 | MS |
NPI | 1083689277 |
---|---|
Provider Name | Lawrence Edward Tamburino |
First Address | Brandon, MS 39042-2401 |
Second Address | Brandon, MS 39042-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 27/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00120860 | (05) | MS |
U71448 | (02) |