Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 30723 | KY |
Y | 111NI0900X | Internist | 30723 | KY |
N | 207R00000X | Internist | ME74515 | FL |
N | 111NI0900X | Internist | ME74515 | FL |
NPI | 1003803412 |
---|---|
Provider Name | Chaker Dahan |
First Address | Windermere, FL 34786-5627 |
Second Address | Windermere, FL 34786-5627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 29/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4629 | BCBS (01) | FL |
F51099 | (02) |