Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | DO00619 | RI |
Y | 207QS0010X | Family Doctor - Sports Medicine | DO 00619 | RI |
NPI | 1134173206 |
---|---|
Provider Name | Amity Rubeor |
First Address | Cranston, RI 02920-5536 |
Second Address | Cranston, RI 02920-5536 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2006 |
Last Update Date | 28/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AR68301 | (05) | RI |