Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME82923 | FL |
Y | 208600000X | Surgeon | ME82923 | FL |
NPI | 1023083177 |
---|---|
Provider Name | John Christofer Dali |
First Address | Fort Walton Beach, FL 32547-6707 |
Second Address | Fort Walton Beach, FL 32547-6707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 03/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01075 | BCBSFL (01) | FL |
262332300 | (05) | FL |
H43850 | (02) | FL |