Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | OS0006354 | FL |
NPI | 1851305635 |
---|---|
Provider Name | Dr. Scott D. Kazdan |
First Address | Pembroke Pines, FL 33028-1015 |
Second Address | Pembroke Pines, FL 33028-1015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 09/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G58895 | (02) |