Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | OS11328 | FL |
NPI | 1023088291 |
---|---|
Provider Name | Dr. Eric John Kujawski |
First Address | Pensacola, FL 32513-2699 |
Second Address | Pensacola, FL 32503-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 30/10/2012 |