Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN15621 | FL |
NPI | 1053329995 |
---|---|
Provider Name | Dr. Abdul Majid Azizi |
First Address | Sanford, FL 32771-7164 |
Second Address | Mount Dora, FL 32757-6708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2006 |
Last Update Date | 04/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053329995 | (02) | FL |