Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | ME136133 | FL |
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME136133 | FL |
N | 207ND0900X | Dermatopathologist | ME136133 | FL |
N | 207NS0135X | Procedural Dermatology | ME136133 | FL |
NPI | 1366823775 |
---|---|
Provider Name | Dr. Tarek S Shaath |
First Address | Altamonte Springs, FL 32714-1838 |
Second Address | The Villages, FL 32162-2697 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2015 |
Last Update Date | 20/04/2020 |