Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD91126 | FL |
NPI | 1023128345 |
---|---|
Provider Name | James Solomon |
First Address | Maitland, FL 32751-7176 |
Second Address | Ormond Beach, FL 32174-9435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 05/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
270445500 | (05) | FL |
B97762 | (02) | FL |