Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME54351 | FL |
N | 111NI0900X | Internist | ME54351 | FL |
N | 207RX0202X | Medical Oncology | 2015-02345 | NC |
Y | 207RX0202X | Medical Oncology | ME54351 | FL |
NPI | 1104817063 |
---|---|
Provider Name | Jameel Audeh |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Sarasota, FL 34236-6908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 11/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C87863 | (02) | FL |