Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | ME133420 | FL |
N | 208D00000X | General Practice Physician | ME133420 | FL |
NPI | 1154700888 |
---|---|
Provider Name | Payton Furman Sellers |
First Address | Bradenton, FL 34207-4611 |
Second Address | Bradenton, FL 34207-4611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2015 |
Last Update Date | 29/05/2019 |