Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | ME0040107 | FL |
NPI | 1245223205 |
---|---|
Provider Name | Stephen Jeffrey Kornfeld |
First Address | Palm Harbor, FL 34684-2648 |
Second Address | Palm Harbor, FL 34684-2648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0205005 | UNITED HEALTHCARE # (01) | FL |
62366 | BC/BS PROVIDER # (01) | FL |
D65339 | (02) | FL |