Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ME68455 | FL |
N | 208600000X | Surgeon | ME68455 | FL |
Y | 2086S0102X | Surgical Critical Care | ME0068455 | FL |
NPI | 1104806256 |
---|---|
Provider Name | Matthew W Lube |
First Address | Orlando, FL 32806-1122 |
Second Address | Orlando, FL 32806-1122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 06/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
263301900 | (05) | FL |
G37626 | (02) | FL |