Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | Q5612 | TX |
N | 208600000X | Surgeon | Q5612 | TX |
Y | 2086S0129X | Vascular Surgeon | ME145283 | FL |
NPI | 1083878300 |
---|---|
Provider Name | Laith Adli Al Balbissi |
First Address | Orlando, FL 32819-8000 |
Second Address | Orlando, FL 32819-8000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2008 |
Last Update Date | 13/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
106291400 | (05) | FL |
200606530 A | (05) | OK |
352164301 | (05) | TX |
352164302 | (05) | TX |
63075211 | (05) | NM |