Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 04-22575 | KS |
NPI | 1043275191 |
---|---|
Provider Name | Dr. Byron B Alexander |
First Address | Manhattan, KS 66502-0428 |
Second Address | Manhattan, KS 66502-2868 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 28/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E29273 | (02) | KS |