Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | ME0075762 | FL |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | ME75762 | FL |
Y | 207VG0400X | Gynecologist | ME75762 | FL |
NPI | 1265497663 |
---|---|
Provider Name | Samuel Del Rio |
First Address | Belfast, ME 04915-4005 |
Second Address | Merritt Island, FL 32952-3601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 15/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
254387700 | (05) | FL |
G71301 | (02) |