Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | ME77859 | FL |
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME77859 | FL |
NPI | 1053421446 |
---|---|
Provider Name | Scott Podnos |
First Address | Maitland, FL 32751-7176 |
Second Address | Weston, FL 33326-4509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 16/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
257778000 | (05) | FL |
H00195 | (02) | FL |