Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | CRM 52331746 | ZZ |
NPI | 1003056037 |
---|---|
Provider Name | Dr. Frits Sutmoller |
First Address | Rio De Janeiro, RJ 22410950 |
Second Address | Rio De Janeiro, RJ 22410950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2009 |
Last Update Date | 04/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
52331746 | CRM (01) |