Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | ME 43828 | FL |
NPI | 1003861469 |
---|---|
Provider Name | Jose S Selem |
First Address | Coral Gables, FL 33134-4712 |
Second Address | Coral Gables, FL 33134-4712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 12/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
068561500 | (05) | FL |
D63895 | (02) | FL |