Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME100515 | FL |
N | 111NI0900X | Internist | ME100515 | FL |
N | 207RH0000X | Hematologist | ME100515 | FL |
Y | 207RX0202X | Medical Oncology | ME100515 | FL |
NPI | 1245439702 |
---|---|
Provider Name | Dr. Julia A. Cogburn |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Tampa, FL 33613-4679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2007 |
Last Update Date | 08/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000081200 | (05) | FL |