Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | ME13603 | FL |
NPI | 1013926849 |
---|---|
Provider Name | Robert V Farese |
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 | 08/08/2006 |
Last Update Date | 28/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50474 | BLUE CROSS BLUE SHIELD (01) | FL |
D62668 | (02) | FL |