Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME0058563 | FL |
NPI | 1104867274 |
---|---|
Provider Name | Irving B David |
First Address | Fort Lauderdale, FL 33308-4603 |
Second Address | Fort Lauderdale, FL 33308-4603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 15/06/2012 |