Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS3902 | FL |
NPI | 1467568915 |
---|---|
Provider Name | Lloyd Dawson Gladding |
First Address | Fort Myers, FL 33916-7526 |
Second Address | Fort Myers, FL 33916-7526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E32177 | (02) | FL |