Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME83785 | FL |
Y | 2080P0208X | Pediatric Infectious Diseases | ME83785 | FL |
NPI | 1316061864 |
---|---|
Provider Name | Nizar Fuad Maraqa |
First Address | Jacksonville, FL 32231-4008 |
Second Address | Jacksonville, FL 32209-6511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 25/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000953279A | (05) | GA |
2647087-00 | (05) | FL |