Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ME121266 | FL |
N | 208600000X | Surgeon | ME121266 | FL |
N | 2086S0102X | Surgical Critical Care | 72462-20 | WI |
Y | 2086S0102X | Surgical Critical Care | ME121266 | FL |
NPI | 1235457458 |
---|---|
Provider Name | Akram Mouied Alashari |
First Address | Jacksonville, FL 32216-3623 |
Second Address | Melbourne, FL 32901-3224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2010 |
Last Update Date | 19/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105561300 | (05) | FL |
PENDING | MEDICARE (01) | FL |