Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | ME40962 | FL |
NPI | 1265412068 |
---|---|
Provider Name | Phil Rhiddlehoover |
First Address | Cedar Key, FL 32625-0375 |
Second Address | Gainesville, FL 32607-2245 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 22/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D21570 | (02) | FL |