Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 34.008816 | OH |
N | 208600000X | Surgeon | 34.008816 | OH |
Y | 2086S0102X | Surgical Critical Care | OS 10402 | FL |
NPI | 1013180447 |
---|---|
Provider Name | Dr. Setu A Dalal |
First Address | Fort Pierce, FL 34950-4838 |
Second Address | Fort Pierce, FL 34950-4838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2008 |
Last Update Date | 15/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000431300 | (05) | FL |
P00691798 | RR MEDICARE (01) | FL |