Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | MD06041 | RI |
NPI | 1093711830 |
---|---|
Provider Name | David Robert Katzen |
First Address | Warwick, RI 02886-6100 |
Second Address | Warwick, RI 02886-6100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9000465 | (05) | RI |
C89692 | (02) | RI |