2) First name

3) Middle name, suffix

4) Type of degree

MD - MEDICAL DOCTOR
UO - OSTEOPATHIC RESIDENT REGISTRATION
DO - OSTEOPATHIC PHYSICIAN
TRN - REGISTRATION FOR RESIDENT/HSE       PHYSICIAN
LL - LIMITED LICENSE MEDICAL DOCTOR
ACN - MEDICAL DOCTOR AREA CRITICAL NEED
MFC - MEDICAL FACULTY CERTIFICATE
LL - OSTEOPATHIC LIMITED LICENSE
PPC - MEDICAL DOCTOR PUBLIC PSYCHIATRY CERTIFICATE
LD - MEDICAL DOCTOR LIMITED TO MAYO CLINIC
PHC - MEDICAL DOCTOR PUBLIC HEALTH CERTIFICATE

5) Gender

6) Specialty

7) Telephone number

8) Expiration date (Florida permit)

9) Rank (Florida license type)

10) License number (Florida)

11) NPI Medicare number

12) UPIN Medicare number

14) Florida county or out of state

15) Year of birth

16) Mailing address, street

17) Florida license status

18) Description (Florida license status)

19) Florida professional code

20) Florida license ID number

21) Fax number

22) Mailing address, city, state and zip code

23) Florida board discipline taken

24) Email address