Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0000X | Obstetrician | 36064 | IA |
Y | 207VX0201X | Gynecologic Oncologist | ME101211 | FL |
NPI | 1255382982 |
---|---|
Provider Name | Paul Wojciech Nowicki |
First Address | Jacksonville, FL 32232-5278 |
Second Address | Jacksonville, FL 32207-8432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 12/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000224800 | (05) | FL |
703246420B | (05) | GA |
I50454 | (02) | |
P01265915 | RR MEDICARE (01) | FL |