Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME88868 | FL |
N | 207ND0101X | MOHS-Micrographic Surgeon | ME88868 | FL |
N | 207NS0135X | Procedural Dermatology | ME88868 | FL |
NPI | 1053332130 |
---|---|
Provider Name | Supriya Tomar |
First Address | West Palm Beach, FL 33401-3404 |
Second Address | West Palm Beach, FL 33401-3404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2006 |
Last Update Date | 28/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I06443 | (02) | FL |