Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO-0002754 | FL |
NPI | 1447349915 |
---|---|
Provider Name | Michael Simmons |
First Address | Homestead, FL 33033-7600 |
Second Address | Homestead, FL 33033-7600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 04/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
390443100 | (05) | FL |
U72304 | (02) | FL |