Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | ME91254 | FL |
NPI | 1063500015 |
---|---|
Provider Name | Dr. Amos Olabisi Dare |
First Address | Boca Raton, FL 33488 |
Second Address | Jacksonville, FL 32211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 27/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
271212100 | (05) | FL |
I22027 | (02) | FL |