Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | OS10139 | FL |
NPI | 1083639561 |
---|---|
Provider Name | Mikhail Vaysberg |
First Address | Oviedo, FL 32765-9290 |
Second Address | Orlando, FL 32828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 21/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
278754700 | (05) | FL |