Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | ME119700 | FL |
NPI | 1093923450 |
---|---|
Provider Name | Dr. Ryan M Ilgenfritz |
First Address | Rockland, DE 19732-0191 |
Second Address | Orlando, FL 32827-7402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 24/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013636800 | (05) | FL |