Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 35072102M | OH |
N | 208600000X | Surgeon | 35072102M | OH |
Y | 2086X0206X | Surgical Oncologist | ME114413 | FL |
NPI | 1174580492 |
---|---|
Provider Name | Eleftherios P Mamounas |
First Address | Orlando, FL 32806-1110 |
Second Address | Orlando, FL 32806-1110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 28/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007147900 | (05) | FL |
0962490 | (05) | OH |
E76359 | (02) | |
ME114413 | MEDICAL LICENSE (01) | FL |