Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | ME110311 | FL |
Y | 207RI0011X | Interventional Cardiology | ME110311 | FL |
NPI | 1104099456 |
---|---|
Provider Name | Basiem William Barsoum |
First Address | Apopka, FL 32703-9210 |
Second Address | Apopka, FL 32703-9210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 12/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03847600 | (05) | FL |