Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | ME71010 | FL |
NPI | 1043269970 |
---|---|
Provider Name | Mr. Tod Joseph Fusia |
First Address | Tampa, FL 33607-6330 |
Second Address | Tampa, FL 33607-6330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 26/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
255128400 | (05) | FL |
E45536 | (02) | FL |