Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN8253 | FL |
NPI | 1083728174 |
---|---|
Provider Name | Dr. Michael J Ruelf |
First Address | Tampa, FL 33612 |
Second Address | Tampa, FL 33612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0775151 | (05) | FL |