Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | OS10260 | FL |
NPI | 1174717276 |
---|---|
Provider Name | Thomas Lupoli |
First Address | Jacksonville, FL 32216-4210 |
Second Address | Orange Park, FL 32073-4466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2007 |
Last Update Date | 08/03/2012 |