Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD.11348R | LA |
N | 208000000X | Pediatrician | ME0069224 | FL |
Y | 2080P0203X | Pediatric Critical Care Doctor | ME69224 | FL |
NPI | 1013967744 |
---|---|
Provider Name | Dr. Emad S Mansour |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33908-3618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 29/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
275311100 | (05) | FL |
G09152 | (02) |