Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | ME84160 | FL |
N | 208000000X | Pediatrician | ME84160 | FL |
NPI | 1194721522 |
---|---|
Provider Name | Dr. Rajivi Pothiraj Rucker |
First Address | Sarasota, FL 34239-2221 |
Second Address | Sarasota, FL 34239-2221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 21/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004579100 | (05) | FL |
48958 | FL BLUE (01) | FL |
KI170 | MEDICARE (01) | FL |