Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | ME0067977 | FL |
NPI | 1013951839 |
---|---|
Provider Name | Marc E Bosem |
First Address | Weston, FL 33326-3255 |
Second Address | Weston, FL 33326-3255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 19/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
37839950 | (05) | FL |
378399500 | (05) | FL |
G10352 | (02) |