Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | ME86456 | FL |
NPI | 1063492809 |
---|---|
Provider Name | Ely Brand |
First Address | Hollywood, FL 33081-0967 |
Second Address | Pembroke Pines, FL 33028-1023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 09/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
78617 | BCBS OF FL (01) | FL |
A52712 | (02) |