Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 215117 | MA |
Y | 208800000X | Urologist | ME95299 | FL |
NPI | 1063450773 |
---|---|
Provider Name | Ralph Zagha |
First Address | Lauderdale Lakes, FL 33313-1600 |
Second Address | Lauderdale Lakes, FL 33313-1600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 20/09/2012 |