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Individual
MYO WIN
Active
Individual
MYO WIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME86765
FL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
ME86765
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267233200
—
FL
01
—
41919
BCBS
FL
Enumeration date
09/06/2005
Last updated
11/04/2016
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