Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 01028666A | IN |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 01028666A | IN |
NPI | 1235108424 |
---|---|
Provider Name | David P Rardon |
First Address | Indianapolis, IN 46268-3129 |
Second Address | Indianapolis, IN 46290-1028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 06/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100259700 | (05) | IN |
B29452 | (02) | IN |