Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 125053281 | IL |
Y | 207T00000X | Neurosurgeon | OS12088 | FL |
NPI | 1093044216 |
---|---|
Provider Name | Dr. John Selim Soliman |
First Address | Lutz, FL 33558-5255 |
Second Address | Lutz, FL 33558-5255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2009 |
Last Update Date | 18/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OS12088 | FLORIDA LICENSE (01) | FL |