Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RP1001X | Pulmonary Disease | MD56742 | TN |
Y | 207RP1001X | Pulmonary Disease | ME47752 | FL |
NPI | 1003877325 |
---|---|
Provider Name | Marlon Amos Labi |
First Address | Pompano Beach, FL 33062-6926 |
Second Address | Pompano Beach, FL 33062-6926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 19/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
94458Z | MEDICARE ID (01) | FL |
D63244 | (02) | FL |