Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | ME104744 | FL |
NPI | 1225001126 |
---|---|
Provider Name | Mildred Ruth Sabo |
First Address | Stuart, FL 34997-6405 |
Second Address | Stuart, FL 34997-6405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 14/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BS2373265 | DEA (01) | FL |
D05202000 | NJ CDS (01) | NJ |
F73224 | (02) |