Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | ME107387 | FL |
NPI | 1013168723 |
---|---|
Provider Name | Osman S Farooq |
First Address | Longwood, FL 32750-5119 |
Second Address | Longwood, FL 32750-5119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2008 |
Last Update Date | 14/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005546900 | (05) | FL |
ME107387 | MEDICAL LICENSE (01) | FL |