Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | ME 53998 | FL |
Y | 207QS0010X | Family Doctor - Sports Medicine | ME53998 | FL |
NPI | 1164483376 |
---|---|
Provider Name | Paul J. Rucinski |
First Address | Gainesville, FL 32607-2245 |
Second Address | Ocala, FL 34471-4656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 19/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07666 | BCBS (01) | FL |
E21551 | (02) | FL |