Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | ME0025368 | FL |
NPI | 1225095227 |
---|---|
Provider Name | Robert Paul Derhagopian |
First Address | South Miami, FL 33143-4828 |
Second Address | South Miami, FL 33143-4828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 09/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003720 | AVMED HEALTH PLAN (01) | FL |
00471 | NEIGHBORHOOD HEALTH PLAN (01) | FL |
4238125 | AETNA HEALTH PLAN (01) | FL |
44135 | BLUE CROSS/BLUE SHIELD (01) | FL |