Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | ME45210 | FL |
NPI | 1174747737 |
---|---|
Provider Name | Bruce R Dooley |
First Address | Jensen Beach, FL 34957 |
Second Address | Ft. Lauderdale, FL 33304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D67375 | (02) | FL |