Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | DN22323 | FL |
N | 213EG0000X | General Practice | DN22323 | FL |
Y | 1223P0221X | Pediatric Dentist | DN22323 | FL |
NPI | 1043768328 |
---|---|
Provider Name | Dr. John Tawadrous |
First Address | Sanford, FL 32771 |
Second Address | Winter Park, FL 32789-2947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2016 |
Last Update Date | 31/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021314900 | (05) | FL |