Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME86612 | FL |
NPI | 1013932698 |
---|---|
Provider Name | Dr. Brittain F Kulow |
First Address | Fort Walton Beach, FL 32547-6742 |
Second Address | Fort Walton Beach, FL 32547-6742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7129491 | AETNA (01) | |
71665 | BLUE CROSS (01) | FL |
H86121 | (02) |