Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 244248 | NY |
N | 208600000X | Surgeon | 244248 | NY |
N | 2086S0102X | Surgical Critical Care | 244248 | NY |
Y | 2086S0102X | Surgical Critical Care | ME140937 | FL |
N | 2086S0127X | Trauma Surgeon | 244248 | NY |
NPI | 1194993105 |
---|---|
Provider Name | Fahd Ali |
First Address | Orlando, FL 32803-1248 |
Second Address | Orlando, FL 32803-1248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2008 |
Last Update Date | 08/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03017163 | (05) | NY |
P00636829 | RAILROAD MEDICARE (01) | NY |