Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 058523 | MI |
N | 207V00000X | Obstetrician & Gynecologist | ME100296 | FL |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | ME100296 | FL |
NPI | 1336216704 |
---|---|
Provider Name | Mrs. Marja J Sprock |
First Address | Rockledge, FL 32955 |
Second Address | Rockledge, FL 32955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 22/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G46847 | (02) | |
G46847 | (02) | FL |
MS058523 | COMMERCIAL-COMMERCIAL NUMBER (01) |