Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YP0228X | Pediatric Otolaryngology | ME92036 | FL |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME92036 | FL |
NPI | 1801902739 |
---|---|
Provider Name | Saswata Roy |
First Address | Jacksonville, FL 32223-1627 |
Second Address | Jacksonville, FL 32223-1835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 30/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
271475200 | (05) | FL |
I23518 | (02) |