Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 14391 | AZ |
NPI | 1033167093 |
---|---|
Provider Name | Robert Mark Rummel |
First Address | Prescott, AZ 86301-1607 |
Second Address | Prescott, AZ 86301-1607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 16/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
250192 | (05) | AZ |
E41203 | (02) |