Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME73434 | FL |
NPI | 1023017803 |
---|---|
Provider Name | Melissa E Carlson |
First Address | West Palm Beach, FL 33407 |
Second Address | Wellington, FL 33414-3164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 25/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
252317500 | (05) | FL |
G24159 | (02) | FL |