Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME61164 | FL |
N | 2080P0204X | Pediatric Emergency Doctor | ME61164 | FL |
NPI | 1194760405 |
---|---|
Provider Name | Ligio Antonio Tavarez |
First Address | Tampa, FL 33655-0001 |
Second Address | Miami, FL 33176-2118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 08/07/2007 |