Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | ME78529 | FL |
NPI | 1033261086 |
---|---|
Provider Name | Susan Patrick Rodell |
First Address | Boca Raton, FL 33486-2346 |
Second Address | Boca Raton, FL 33486-2346 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H30385 | (02) | FL |