Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 036126050 | IL |
Y | 207KA0200X | Allergist | ME91504 | FL |
NPI | 1144396334 |
---|---|
Provider Name | Vesselin Dimov |
First Address | Weston, FL 33331-3609 |
Second Address | Weston, FL 33331-3609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 09/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2561188 | (05) | OH |
I29152 | (02) | OH |