Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO4048 | FL |
NPI | 1023468295 |
---|---|
Provider Name | Kevin Allen Tootle |
First Address | Celebration, FL 34747-5434 |
Second Address | Celebration, FL 34747-5434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2016 |
Last Update Date | 18/02/2019 |