Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME0056028 | FL |
Y | 207XS0106X | Orthopaedic Hand Surgeon | ME0056028 | FL |
NPI | 1124027867 |
---|---|
Provider Name | Dr. Wadih S. Macksoud |
First Address | Winter Park, FL 32789-4949 |
Second Address | Orlando, FL 32806-2944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 15/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
061726100 | (05) | FL |
09393 | BC/BS (01) | FL |
200030018 | RAILROAD (01) | FL |
C48885 | (02) | FL |