Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | PA9111176 | FL |
NPI | 1124512694 |
---|---|
Provider Name | Ruth Fookes |
First Address | Orlando, FL 32803-1460 |
Second Address | Orlando, FL 32803-1460 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2018 |
Last Update Date | 19/06/2018 |