Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME128445 | FL |
NPI | 1043453350 |
---|---|
Provider Name | Matthew Clavenna |
First Address | Clearwater, FL 33761-2013 |
Second Address | Clearwater, FL 33756-3313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2009 |
Last Update Date | 05/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17487300 | (05) | FL |
IQ285Z | (02) | FL |