Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 030848 | GA |
NPI | 1053308262 |
---|---|
Provider Name | Dr. Rudolf G Nunnemann |
First Address | Brunswick, GA 31520-4219 |
Second Address | Brunswick, GA 31520-4219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B90889 | (02) | GA |