Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | ME0061059 | FL |
Y | 207RX0202X | Medical Oncology | ME0061059 | FL |
NPI | 1457316341 |
---|---|
Provider Name | Ralph Gousse |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Altamonte Springs, FL 32701-4802 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 10/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
377436800 | (05) | FL |
F96132 | (02) |