Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME88921 | FL |
N | 207ND0101X | MOHS-Micrographic Surgeon | ME88921 | FL |
NPI | 1487617700 |
---|---|
Provider Name | Miranda Whitmer |
First Address | Manitowoc, WI 54220-4630 |
Second Address | Gainesville, FL 32607-6652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 10/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I34086 | (02) | FL |