Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ME87949 | FL |
Y | 208D00000X | General Practice Physician | ME87949 | FL |
NPI | 1053310342 |
---|---|
Provider Name | Dr. Jamal A Abusuwa |
First Address | Oviedo, FL 32765-6212 |
Second Address | Oviedo, FL 32765-6212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 30/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
268174900 | (05) | FL |
43010 | BCBS (01) | FL |
I14889 | (02) | FL |