Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | ME131763 | FL |
NPI | 1801097142 |
---|---|
Provider Name | Marian Porubsky |
First Address | Tampa, FL 33601-1289 |
Second Address | Tampa, FL 33606-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2007 |
Last Update Date | 08/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020465700 | (05) | FL |