Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | ME90489 | FL |
NPI | 1154421766 |
---|---|
Provider Name | Tarak Choksi |
First Address | Tampa, FL 33694-0658 |
Second Address | Lutz, FL 33548-4922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 20/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
272816800 | (05) | FL |
H66400 | (02) | FL |