Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME89989 | FL |
NPI | 1003849001 |
---|---|
Provider Name | Bahram Ahmadi |
First Address | Sebring, FL 33870-1049 |
Second Address | Sebring, FL 33870-1049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 25/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
270602400 | (05) | FL |
48293 | BCBS (01) | FL |
I16190 | (02) | |
P00189601 | RAILROAD MEDICARE (01) |