Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | UO3827 | FL |
N | 207Q00000X | Family Doctor | UO3827 | FL |
NPI | 1265854897 |
---|---|
Provider Name | Dr. Rohit Shori Mehra |
First Address | Davie, FL 33329-0370 |
Second Address | Davie, FL 33328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2014 |
Last Update Date | 30/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OS14322 | NMOMM (01) | FL |
UO3827 | TRAINING LICENSE (01) | FL |