Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 04-19807 | KS |
NPI | 1558372102 |
---|---|
Provider Name | David Allan Grainger |
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 | 10/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E41131 | (02) | KS |