Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | POOOO1692 | FL |
NPI | 1336177401 |
---|---|
Provider Name | Paul J Kalin |
First Address | Fort Walton Beach, FL 32547-6723 |
Second Address | Fort Walton Beach, FL 32547-6723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T54875 | (02) | FL |