Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 12011554A | IN |
NPI | 1477750263 |
---|---|
Provider Name | Dr. Mohammed Nadimul Islam |
First Address | Gainesville, FL 32601-8497 |
Second Address | Gainesville, FL 32610-0405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 27/11/2012 |