Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | ME0090853 | FL |
NPI | 1245225762 |
---|---|
Provider Name | Dr. Jacob Tangir |
First Address | Miramar, FL 33027-2903 |
Second Address | Miramar, FL 33027-3661 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 12/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
270798500 | (05) | FL |
52128 | BCBS OF FL. PROVIDER # (01) | FL |
H36639 | (02) | FL |