Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | ME148417 | FL |
N | 207W00000X | Ophthalmologist | S0810 | TX |
NPI | 1033536396 |
---|---|
Provider Name | Phillip Alan Tenzel |
First Address | Boca Raton, FL 33433-8233 |
Second Address | Ft Lauderdale, FL 33308-4510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2014 |
Last Update Date | 06/07/2021 |