Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 2002009759 | MO |
Y | 111NI0900X | Internist | 2002009759 | MO |
NPI | 1003808437 |
---|---|
Provider Name | Carl D Dirks |
First Address | Kansas City, MO 64131-9712 |
Second Address | Kansas City, MO 64111-5941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2005 |
Last Update Date | 16/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H58556 | (02) |