Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME32583 | FL |
NPI | 1043270853 |
---|---|
Provider Name | Dr. Kathi A. Aultman |
First Address | Jacksonville, FL 32245-6568 |
Second Address | Orange Park, FL 32003-4806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 21/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
039579000 | (05) | FL |
D50067 | (02) | FL |