Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME125487 | FL |
NPI | 1063737492 |
---|---|
Provider Name | Ross Wodicka |
First Address | Oakland Park, FL 33334-3406 |
Second Address | Oakland Park, FL 33334-3406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2010 |
Last Update Date | 14/09/2016 |