Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | ME0017794 | FL |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | ME0017794 | FL |
NPI | 1548261472 |
---|---|
Provider Name | Ibrahim Bohsali |
First Address | Fort Pierce, FL 34950-4864 |
Second Address | Fort Pierce, FL 34950-4864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D56743 | (02) |