Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME100547 | FL |
N | 207QS0010X | Family Doctor - Sports Medicine | 25MA08132800 | NJ |
N | 207QS0010X | Family Doctor - Sports Medicine | M2164 | TX |
N | 207QS0010X | Family Doctor - Sports Medicine | MD430258 | PA |
N | 207QS0010X | Family Doctor - Sports Medicine | ME100547 | FL |
NPI | 1023120664 |
---|---|
Provider Name | Leon Camilo Uribe |
First Address | West Palm Beach, FL 33417-4544 |
Second Address | West Palm Beach, FL 33417-4544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 28/07/2014 |