Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | POR15 | FL |
N | 222Z00000X | Podiatrist | POR15 | FL |
Y | 224P00000X | Prosthetist | POR15 | FL |
N | 225000000X | Orthotic Fitter | POR15 | FL |
NPI | 1013163104 |
---|---|
Provider Name | Ruphlal Robert Gooljar |
First Address | Jacksonville, FL 32247-5720 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2008 |
Last Update Date | 08/08/2008 |