| NPI | 1790149516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY ALLYN RUTERBUSCH Physician 904-589-0750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: FL OS6403) |
| Additional Taxonomies | 133N00000X Nutritionist |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: FL OS6403) | |
| 305R00000X Preferred Provider Organization (Licence: FL OS6403) | |
| Enumeration Date | 2016-04-07 |
| Last Update Date | 2016-10-10 |