Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 04-25712 | KS |
NPI | 1114961422 |
---|---|
Provider Name | Dr. Edward N Letourneau |
First Address | Topeka, KS 66606-1670 |
Second Address | Topeka, KS 66606-1670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 14/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
067096 | MEDICARE PTAN (01) | KS |
100174270B | (05) | KS |