Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | R9N91 | MO |
Y | 208600000X | Surgeon | R9N91 | MO |
N | 2086S0129X | Vascular Surgeon | R9N91 | MO |
NPI | 1063625317 |
---|---|
Provider Name | Lyle G Breeding |
First Address | Brooksville, FL 34613-5414 |
Second Address | Brooksville, FL 34613-5414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 14/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C54793 | (02) |