Individual
Inactive
Individual
Inactive
Sole proprietor
Provider details
NPI number
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME30356
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93780
BLUE CROSS BLUE SHIELD
FL
01
—
P00262636
RAILROAD MEDICARE
FL
Enumeration date
—
Last updated
—
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