Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | OS11586 | FL |
NPI | 1295996106 |
---|---|
Provider Name | Dr. Amer Ansari |
First Address | Jensen Beach, FL 34957-3600 |
Second Address | Kissimmee, FL 34741-7562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2008 |
Last Update Date | 23/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100347800 | (05) | FL |
103833000 | (05) | FL |
14JK0 | BCBS (01) | FL |