Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 30194 | TX |
NPI | 1083023055 |
---|---|
Provider Name | Karissa A Rumple |
First Address | Eglin Afb, FL 32542-1302 |
Second Address | Eglin Afb, FL 32542-1302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2014 |
Last Update Date | 09/07/2019 |