Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH9328 | FL |
NPI | 1790904449 |
---|---|
Provider Name | Dr. Edwin John Ruby |
First Address | Deland, FL 32724-6813 |
Second Address | Ocala, FL 34474-8458 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |