Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 32236 | AR |
NPI | 1023063005 |
---|---|
Provider Name | Daniel Q Cofie |
First Address | Williamsville, NY 14221-4834 |
Second Address | Williamsville, NY 14221-4834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 18/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1511309 | (05) | TN |
4198140 | BLUE CROSS BLUE SHIELD (01) | TN |
F53904 | (02) | TN |