Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN15272 | FL |
NPI | 1013223965 |
---|---|
Provider Name | Deborah Barckhausen |
First Address | Ocala, FL 34480-6644 |
Second Address | Ocala, FL 34476-6401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2010 |
Last Update Date | 28/08/2010 |