Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DN24072 | FL |
Y | 213EG0000X | General Practice | DN24072 | FL |
NPI | 1003473927 |
---|---|
Provider Name | Dr. Sura Dabbagh |
First Address | Grand Blanc, MI 48439-6320 |
Second Address | Wesley Chapel, FL 33544-8612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2019 |
Last Update Date | 27/05/2019 |