Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO2577 | FL |
NPI | 1598176695 |
---|---|
Provider Name | Livingston Nuamah |
First Address | Santa Rosa Beach, FL 32459-5385 |
Second Address | Santa Rosa Beach, FL 32459-5385 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2014 |
Last Update Date | 13/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U78326 | (02) | FL |