Basic Information
| Provider Information | |||||||||
| NPI: | 1982239570 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SOE | ||||||||
| FirstName: | NWE NWE | ||||||||
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| Credential: | MBBS PHD D(ABHI) | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 919465 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328910001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074229831 | ||||||||
| FaxNumber: | 8556714753 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 E ROLLINS ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328031248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073037683 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2020 | ||||||||
| LastUpdateDate: | 04/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247ZC0005X | DI51072 | FL | Y | Technologists, Technicians & Other Technical Service Providers | Pathology | Clinical Laboratory Director, Non-physician | 207ZP0105X | DI51072 | FL | N | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
No ID Information.