Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G072181 | CA |
Y | 208600000X | Surgeon | G072181 | CA |
N | 2086S0102X | Surgical Critical Care | G072181 | CA |
N | 2086S0127X | Trauma Surgeon | G072181 | CA |
NPI | 1053382085 |
---|---|
Provider Name | Dr. Eric James Kuncir |
First Address | Omaha, NE 68124-2311 |
Second Address | Orange, CA 92868-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2006 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G58455 | (02) | CA |