Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0207X | Pediatric Hematology-Oncologist | ME42258 | FL |
NPI | 1083619621 |
---|---|
Provider Name | Cameron Kamran Tebbi |
First Address | Orlando, FL 32891-0001 |
Second Address | Tampa, FL 33606-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 08/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
062749600 | (05) | FL |
10218 | BLUE CROSS BLUE SHIELD (01) | FL |
E68943 | (02) | FL |