Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MEOO60513 | FL |
NPI | 1255484804 |
---|---|
Provider Name | Dr. Timothy James Exarhos |
First Address | Davie, FL 33328-1365 |
Second Address | Fort Lauderdale, FL 33312-6517 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F06644 | (02) | FL |