Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | ME76386 | FL |
NPI | 1568435832 |
---|---|
Provider Name | Mr. Antonio J Gayoso |
First Address | St Petersburg, FL 33704-3113 |
Second Address | St Petersburg, FL 33704-3113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2006 |
Last Update Date | 06/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070215300 | (05) | FL |
G74710 | (02) | FL |