Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN5005 | FL |
NPI | 1023060787 |
---|---|
Provider Name | Lloyd Lustig Wruble |
First Address | Miami, FL 33156-7706 |
Second Address | Miami, FL 33156-7706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
96597 | (02) | FL |