Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 60359 | KS |
Y | 213EG0000X | General Practice | 60359 | KS |
NPI | 1003801663 |
---|---|
Provider Name | Dallan Greenhalgh |
First Address | Shawnee, KS 66216-2740 |
Second Address | Shawnee, KS 66216-2740 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 22/10/2015 |