Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | ME0045015 | FL |
NPI | 1003874363 |
---|---|
Provider Name | Max T Billingsley |
First Address | Orlando, FL 32886-3026 |
Second Address | Jacksonville, FL 32204-4748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 01/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
044556800 | (05) | FL |
14148 | BCBS (01) | FL |
930000750 | RRMCR (01) | FL |
E12140 | (02) | FL |