Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2020020192 | MO |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 2020020192 | MO |
NPI | 1669901831 |
---|---|
Provider Name | Carl Ryan Tunink |
First Address | Kansas City, MO 64184-3966 |
Second Address | Fulton, MO 65251-2511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2017 |
Last Update Date | 05/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200044317 | (05) | MO |