Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | OS 000 5992 | FL |
Y | 208600000X | Surgeon | OS 000 5992 | FL |
NPI | 1013013127 |
---|---|
Provider Name | Dr. Sam Gershenbaum |
First Address | Aventura, FL 33180-3103 |
Second Address | Aventura, FL 33180-3103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80916 | BLUE CROSS/BLUE SHIELD (01) | FL |
F 32589 | (02) | FL |