Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME63957 | FL |
NPI | 1063462463 |
---|---|
Provider Name | Dr. Phi-Van T Le |
First Address | Pembroke Pines, FL 33028-1013 |
Second Address | Pembroke Pines, FL 33028-1013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 15/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
372801300 | (05) | FL |
BL3579349 | DEA (01) | FL |
F54941 | (02) |