Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 01-05498 | KS |
NPI | 1457600777 |
---|---|
Provider Name | Dr. Dustin Cole Mcphail |
First Address | Ashland, KS 67831-0302 |
Second Address | Ashland, KS 67831-0302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2012 |
Last Update Date | 19/09/2012 |