Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist |
NPI | 1144375684 |
---|---|
Provider Name | Mr. Richard Rodrigue Gingras |
First Address | Bonita Springs, FL 34135-8402 |
Second Address | Naples, FL 34110-9275 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 06/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7795001 | (05) | NC |