Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO2208 | FL |
NPI | 1063500692 |
---|---|
Provider Name | William J Namen II |
First Address | Jacksonville, FL 32257-6152 |
Second Address | Jacksonville Beach, FL 32250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 30/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U46941 | (02) | FL |