Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | OS11781 | FL |
N | 111NI0900X | Internist | OS11781 | FL |
Y | 207RH0002X | Hospice and Palliative Medicine | OS11781 | FL |
NPI | 1083928592 |
---|---|
Provider Name | Ravi Samlal |
First Address | Temple Terrace, FL 33637-0904 |
Second Address | Temple Terrace, FL 33637-0904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2010 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012540200 | (05) | FL |
14W85 | BCBS (01) | FL |
FS3293824 | DEA (01) | |
OS11781 | FL LICENSE (01) | FL |
P01768777 | RAILROAD MEDICARE (01) | FL |