Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | ME0057884 | FL |
NPI | 1053468967 |
---|---|
Provider Name | Robert A. Marino |
First Address | Orange Park, FL 32073-4461 |
Second Address | Orange Park, FL 32073-4461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 05/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000958746A | (05) | GA |
051938300 | (05) | FL |
1RXJ6 | BLUE CROSS BLUE SHIELD (01) | FL |
4200778 | AETNA (01) | FL |
E89930 | (02) | FL |