Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DRPM1792 | FL |
NPI | 1730655192 |
---|---|
Provider Name | Abdulaziz Banasser |
First Address | Gainesville, FL 32610-0001 |
Second Address | Gainesville, FL 32610-3006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2018 |
Last Update Date | 26/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DRPM1792 | FLORIDA DEPARTMENT OF HEALTH (01) | FL |