Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | ME115666 | FL |
NPI | 1245589449 |
---|---|
Provider Name | Paul Khalil |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2012 |
Last Update Date | 26/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
014519700 | (05) | FL |