Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0105X | Surgery of the Hand | ME 30186 | FL |
Y | 2086S0105X | Surgery of the Hand | ME30186 | FL |
NPI | 1699787085 |
---|---|
Provider Name | Robert J. Belsole |
First Address | Orlando, FL 32891-7770 |
Second Address | Tampa, FL 33612-4742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 23/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
039764400 | (05) | FL |
29995 | BLUE CROSS BLUE SHIELD (01) | FL |
D53822 | (02) | FL |