Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YP0228X | Pediatric Otolaryngology | MD2017-0816 | NM |
Y | 207YP0228X | Pediatric Otolaryngology | ME150942 | FL |
NPI | 1427316231 |
---|---|
Provider Name | Dr. Christine Arminda Fordham |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33908-5769 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2012 |
Last Update Date | 16/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110539600 | (05) | FL |