Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | ME73031 | FL |
NPI | 1215962154 |
---|---|
Provider Name | Dr. Wassam M Rahman |
First Address | St Petersburg, FL 33701 |
Second Address | St Petersburg, FL 33701-4634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 22/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
252262400 | (05) | FL |
E16822 | (02) |