Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | ME45555 | FL |
NPI | 1295079630 |
---|---|
Provider Name | Selvon Nanan |
First Address | Plantation, FL 33317-2385 |
Second Address | Plantation, FL 33317-2385 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2012 |
Last Update Date | 26/11/2012 |