Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME117932 | FL |
NPI | 1033438742 |
---|---|
Provider Name | Dr. Salma Z Pothiawala |
First Address | Fort Myers, FL 33908-5182 |
Second Address | Tampa, FL 33647-2199 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2010 |
Last Update Date | 28/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
016614500 | (05) | FL |
389444 | AVMED (01) | FL |
L1UUX | FLORIDA BLUE (01) | FL |