Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | P0929 | FL |
Y | 222Z00000X | Podiatrist | P0929 | FL |
NPI | 1073512695 |
---|---|
Provider Name | Robert M Case |
First Address | Port Charlotte, FL 33952-5165 |
Second Address | Port Charlotte, FL 33952-5126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 01/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
87617 | BLUE CROSS BLUE SHIELD (01) | FL |
T55473 | (02) | FL |