Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | P01338 | FL |
Y | 222Z00000X | Podiatrist | P01338 | FL |
NPI | 1073535787 |
---|---|
Provider Name | Michael Gary Demner |
First Address | Largo, FL 33777-1251 |
Second Address | Largo, FL 33777-1251 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
87709 | BCBS (01) | |
T55512 | (02) |