Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | F4462 | TX |
NPI | 1053393132 |
---|---|
Provider Name | Elizabeth Wooten Rutledge |
First Address | Austin, TX 78759-4093 |
Second Address | Round Rock, TX 78681-4007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 09/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B26074 | (02) | TX |