Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | MA8994 | FL |
NPI | 1144428046 |
---|---|
Provider Name | Mr. Rusty Louis Crews |
First Address | Land O Lakes, FL 34639-6110 |
Second Address | Land O Lakes, FL 34639-6110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 08/07/2007 |