Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | ME101956 | FL |
N | 2081P2900X | Pain Medicine | ME101956 | FL |
NPI | 1154467553 |
---|---|
Provider Name | Dr. Omar Quiles |
First Address | Kissimmee, FL 34742-0037 |
Second Address | Orlando, FL 32807-3120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 28/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ME101956 | FLORIDA LICENSE (01) | FL |