Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MA29742 | FL |
NPI | 1013156025 |
---|---|
Provider Name | Mr. John Edwin French |
First Address | Gainesville, FL 32605-1765 |
Second Address | Gainesville, FL 32609-5403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2009 |
Last Update Date | 28/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C1238 | BLUE CROSS / BLUE SHIELD OF FLORIDA (01) | FL |