Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME59683 | FL |
NPI | 1063417665 |
---|---|
Provider Name | Mark Steven Nestor |
First Address | Aventura, FL 33180-3108 |
Second Address | Aventura, FL 33180-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 29/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E87088 | (02) | FL |