Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0000X | Hematologist | ME94112 | FL |
NPI | 1336166230 |
---|---|
Provider Name | Mohamed A Kharfan Dabaja |
First Address | Jacksonville, FL 32224-1865 |
Second Address | Jacksonville, FL 32224-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 31/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
273564400 | (05) | FL |
29270 | BLUE CROSS BLUE SHIELD (01) | FL |