Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH3653 | FL |
NPI | 1154347029 |
---|---|
Provider Name | Dr. Randolph V. Hansbrough |
First Address | Stuart, FL 34994-3054 |
Second Address | Stuart, FL 34994-3054 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |