Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | ME65965 | FL |
NPI | 1588609556 |
---|---|
Provider Name | Mark S Chaet |
First Address | Orlando, FL 32806-1108 |
Second Address | Orlando, FL 32806-1108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G14735 | (02) | FL |