Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 46001 | FL |
NPI | 1013004985 |
---|---|
Provider Name | Mr. Bruce Peter Young |
First Address | Lighthouse Point, FL 33064-7744 |
Second Address | Lighthouse Point, FL 33064-7744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D63272 | (02) |