Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DRPM2091 | FL |
NPI | 1093359226 |
---|---|
Provider Name | Dr. Lauren Anne Ruddocks |
First Address | Gainesville, FL 32610-0001 |
Second Address | Gainesville, FL 32610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2019 |
Last Update Date | 08/11/2021 |