Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | ME51537 | FL |
NPI | 1275501454 |
---|---|
Provider Name | Mark Alan Greenberg |
First Address | Fort Myers, FL 33907-3619 |
Second Address | Fort Myers, FL 33907-3619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D61300 | (02) | FL |