Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | ME 17057 | FL |
NPI | 1033105390 |
---|---|
Provider Name | Ludwika Harrison |
First Address | Miami Beach, FL 33139-3819 |
Second Address | Miami Beach, FL 33139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 19/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D65645 | (02) |