Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | ME95641 | FL |
NPI | 1053361881 |
---|---|
Provider Name | Mohamad Massan Masri |
First Address | Altamonte Sp, FL 32701-4823 |
Second Address | Altamonte Spg, FL 32701-4823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 02/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BM5839557 | DEA (01) | FL |