Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | ME056744 | FL |
NPI | 1164537973 |
---|---|
Provider Name | Prathima Moorthy |
First Address | Naples, FL 34103 |
Second Address | Naples, FL 34109-3884 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 12/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ME056744 | MEDICAL LICENSE (01) | FL |