Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 43563-020 | WI |
N | 207QS0010X | Family Doctor - Sports Medicine | MD428036 | PA |
Y | 207QS0010X | Family Doctor - Sports Medicine | ME146676 | FL |
NPI | 1114956372 |
---|---|
Provider Name | Richard L Canlas |
First Address | Gainesville, FL 32607-2245 |
Second Address | Gainesville, FL 32607-2245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103459365 | (05) | PA |
34134400 | (05) | WI |
G47187 | (02) |