Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | ME78370 | FL |
NPI | 1033149752 |
---|---|
Provider Name | Dr. Ammar Hemaidan |
First Address | Port Orange, FL 32127-8980 |
Second Address | Port Orange, FL 32127-8980 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 10/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
260588101 | (05) | FL |