Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME96014 | FL |
Y | 111NI0900X | Internist | ME96014 | FL |
N | 207RH0003X | Hematology & Oncology | ME96014 | FL |
NPI | 1043251457 |
---|---|
Provider Name | Samuel Agresta |
First Address | Orlando, FL 32891-7770 |
Second Address | Tampa, FL 33612-9416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 15/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
54281 | BLUE CROSS BLUE SHIELD (01) | FL |
H70374 | (02) | FL |