Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 05-24641 | KS |
NPI | 1497715916 |
---|---|
Provider Name | Bruce Lynn Tjaden |
First Address | Wichita, KS 67226-2182 |
Second Address | Wichita, KS 67226-2182 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 08/07/2007 |