Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME108973 | FL |
N | 111NI0900X | Internist | ME108973 | FL |
Y | 207RC0200X | Critical Care Medicine | ME108973 | FL |
NPI | 1083889083 |
---|---|
Provider Name | Dr. Omid Haghshenas Zad |
First Address | Orlando, FL 32819-3142 |
Second Address | Kissimmee, FL 34741-4924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3218435500 | (05) | FL |
ME108973 | MEDICAL LICENSE (01) | FL |