Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME68229 | FL |
NPI | 1003892100 |
---|---|
Provider Name | Ronald Flaster |
First Address | Sunrise, FL 33323-2853 |
Second Address | Margate, FL 33063-5727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 08/07/2007 |