Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | ME34121 | FL |
NPI | 1013915024 |
---|---|
Provider Name | Sergio R Mather |
First Address | Fort Myers, FL 33906-2707 |
Second Address | Fort Myers, FL 33912-4343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 05/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
067302100 | (05) | FL |
D62345 | (02) |