Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | ME107032 | FL |
NPI | 1245432459 |
---|---|
Provider Name | Dr. Ajmal Aziz Sultan |
First Address | Melbourne, FL 32940-8563 |
Second Address | Titusville, FL 32796-2141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2007 |
Last Update Date | 23/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1495H | BCBS FL (01) | FL |