Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | MFC1592 | FL |
NPI | 1326098500 |
---|---|
Provider Name | Yao-Shan Fan |
First Address | Jacksonville, FL 32224-1865 |
Second Address | Jacksonville, FL 32224-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 24/11/2020 |