Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | ME67777 | FL |
NPI | 1073576567 |
---|---|
Provider Name | Michael Mcmahan |
First Address | Sunrise, FL 33323-2815 |
Second Address | Orlando, FL 32806-2031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 30/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
377167900 | (05) | FL |
F93123 | (02) | FL |