Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | ME39221 | FL |
NPI | 1437121175 |
---|---|
Provider Name | Terry L Ptacek |
First Address | Pensacola, FL 32501-1857 |
Second Address | Pensacola, FL 32501-1857 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 16/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D53338 | (02) | FL |