Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 5101021030 | MI |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | OS16167 | FL |
NPI | 1376956631 |
---|---|
Provider Name | Drew Joseph Iman |
First Address | Jacksonville, FL 32224-1865 |
Second Address | Jacksonville, FL 32224-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2014 |
Last Update Date | 08/07/2019 |