Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | ME41317 | FL |
NPI | 1083631691 |
---|---|
Provider Name | Rex L. Northup |
First Address | Pensacola, FL 32513-2699 |
Second Address | Pensacola, FL 32504-5708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 14/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009711190 | (05) | AL |
01054709 | (05) | MS |
0200362590 | (05) | KS |
04695776 | (05) | MI |
068375200 | (05) | FL |
D53337 | (02) |