Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME68622 | FL |
NPI | 1063442606 |
---|---|
Provider Name | Luis Gerardo Marmol |
First Address | Port Charlotte, FL 33952-5344 |
Second Address | Port Charlotte, FL 33952-5317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 04/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040010592 | RAILROAD MEDICARE (01) | FL |
G07471 | (02) | |
P00609303 | RAILROAD MEDICARE (01) | FL |
P00913646 | RAILROAD MEDICARE (01) |