Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME65248 | FL |
Y | 111NI0900X | Internist | ME65248 | FL |
N | 2081P2900X | Pain Medicine | ME65248 | FL |
NPI | 1114952413 |
---|---|
Provider Name | Dr. Wagdy Tadros |
First Address | Lauderdale Lakes, FL 33319-5876 |
Second Address | Lauderdale Lakes, FL 33319-5876 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 15/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E94260 | (02) | FL |
VADOO | (02) | FL |