Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 013265 | FL |
Y | 213EG0000X | General Practice | 013265 | FL |
NPI | 1003172156 |
---|---|
Provider Name | Dr. Michele A. Dallas |
First Address | Fort Lauderdale, FL 33301 |
Second Address | Fort Lauderdale, FL 33301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2012 |
Last Update Date | 03/04/2012 |