Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | ME56478 | FL |
NPI | 1346212552 |
---|---|
Provider Name | Suzanne T Mastin |
First Address | Orlando, FL 32891-8025 |
Second Address | Gainesville, FL 32610-3003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 05/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
054710700 | (05) | FL |
E94154 | (02) |