Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME83500 | FL |
N | 111NI0900X | Internist | ME83500 | FL |
Y | 207RC0000X | Internist - Cardiovascular Disease | ME83500 | FL |
N | 207RS0012X | Sleep Medicine | ME83500 | FL |
NPI | 1013945815 |
---|---|
Provider Name | Bassam Altajar |
First Address | Palmetto, FL 34221-4737 |
Second Address | Arcadia, FL 34266-3839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 22/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
264341300 | (05) | FL |
G50433 | (02) |