Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | OS11500 | FL |
NPI | 1124323860 |
---|---|
Provider Name | Gina Raptoulis |
First Address | Palm Harbor, FL 34684-3176 |
Second Address | Palm Harbor, FL 34684-3176 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2011 |
Last Update Date | 06/12/2016 |