Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | ME104315 | FL |
NPI | 1073502753 |
---|---|
Provider Name | Mr. Carlos Roberto Midence SR. |
First Address | Miami, FL 33176-2206 |
Second Address | Miami, FL 33176-2206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 24/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D95867 | (02) |