Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DTP 633 | FL |
NPI | 1043668593 |
---|---|
Provider Name | Eman Othman |
First Address | Jacksonville, FL 32211-3321 |
Second Address | Jacksonville, FL 32211-3321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2016 |
Last Update Date | 25/05/2016 |