Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 01072705A | IN |
N | 207T00000X | Neurosurgeon | 072090 | GA |
N | 207T00000X | Neurosurgeon | 35.098155 | OH |
Y | 207T00000X | Neurosurgeon | ME114836 | FL |
NPI | 1073750303 |
---|---|
Provider Name | Dr. Gazanfar Rahmathulla |
First Address | Jacksonville, FL 32209-6533 |
Second Address | Jacksonville, FL 32209-6533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2009 |
Last Update Date | 17/03/2017 |