Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME26602 | FL |
Y | 2080P0210X | Pediatric Nephrologist | ME26602 | FL |
NPI | 1003875972 |
---|---|
Provider Name | Dr. Mohamad Alasad Tolaymat |
First Address | Jacksonville, FL 32231-4008 |
Second Address | Jacksonville, FL 32207-8210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 07/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000190517E | (05) | GA |
0576905-00 | (05) | FL |
390007106 | RAILROAD MEDICARE (01) | FL |
D52528 | (02) | FL |