Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 56579 | WI |
N | 2080P0201X | Pediatric Allergist | 56579 | WI |
N | 2080P0201X | Pediatric Allergist | C10006135 | DE |
Y | 2080P0201X | Pediatric Allergist | ME120908 | FL |
NPI | 1205996402 |
---|---|
Provider Name | Dr. Ejaz Yousef |
First Address | Rockland, DE 19732-0191 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 06/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001680789 | (05) | PA |
0033153424B | (05) | GA |
013670600 | (05) | FL |
1205996402 | (05) | WI |
64050859 | (05) | KY |
8003700 | (05) | NJ |
8301018 | (05) | MD |
G64419 | (02) |