Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223X0400X | Orthodontists | 22D102266700 | NJ |
Y | 1223X0400X | Orthodontists | DN 18230 | FL |
N | 1223X0400X | Orthodontists | DS031546L | PA |
NPI | 1043417934 |
---|---|
Provider Name | Tomas Paul Marrecau |
First Address | Weston, FL 33331-3580 |
Second Address | Hialeah, FL 33012-2100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 07/04/2009 |