Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | ME113190 | FL |
N | 2081P2900X | Pain Medicine | ME113190 | FL |
NPI | 1275506818 |
---|---|
Provider Name | Shariq Latif |
First Address | Marietta, GA 30067-8665 |
Second Address | Palm Coast, FL 32137-8555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 03/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010891600 | (05) | FL |