Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | ME149547 | FL |
Y | 207R00000X | Internist | ME149547 | FL |
Y | 111NI0900X | Internist | ME149547 | FL |
NPI | 1285131045 |
---|---|
Provider Name | Prabhdeep Singh |
First Address | Orange Park, FL 32073-5148 |
Second Address | Orange Park, FL 32073-5148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2018 |
Last Update Date | 28/12/2021 |