Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME 51592 | FL |
NPI | 1033319769 |
---|---|
Provider Name | Richard Mayron |
First Address | Jupiter, FL 33468 |
Second Address | Jupiter, FL 33468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2007 |
Last Update Date | 27/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E21460 | (02) | FL |