Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME85791 | FL |
NPI | 1003842121 |
---|---|
Provider Name | Heba El Goweni |
First Address | Navarre, FL 32566-3612 |
Second Address | Navarre, FL 32566-3612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 13/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
266616200 | (05) | FL |
29224 | BLUE CROSS BLUE SHIELD OF FLORIDA (01) | FL |
591-68677 | BLUE CROSS BLUE SHIELD OF ALABAMA (01) | AL |
H81114 | (02) |