Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME100380 | FL |
N | 111NI0900X | Internist | ME100380 | FL |
N | 207RH0000X | Hematologist | ME100380 | FL |
Y | 207RX0202X | Medical Oncology | ME100380 | FL |
NPI | 1033374301 |
---|---|
Provider Name | Dr. Imad V El-Jassous |
First Address | Fort Myers, FL 33916-2216 |
Second Address | The Villages, FL 32159-6812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2008 |
Last Update Date | 08/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000991700 | (05) | FL |