Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | ME36514 | FL |
NPI | 1174516181 |
---|---|
Provider Name | Dr. Steven Jay Wasserman |
First Address | Venice, FL 34285-4108 |
Second Address | Venice, FL 34285-4108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 30/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D86089 | (02) | FL |