Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | PO1197 | FL |
N | 213ES0000X | Sports Medicine | PO1197 | FL |
Y | 213ES0103X | Foot & Ankle Surgery | PO1197 | FL |
NPI | 1154337012 |
---|---|
Provider Name | Dr. Jeffrey Liss |
First Address | Fort Lauderdale, FL 33301-3637 |
Second Address | Fort Lauderdale, FL 33301-3637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 29/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
029616300 | (05) | FL |
T55484 | (02) | FL |