Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 7424 | NV |
Y | 207KA0200X | Allergist | M2893 | ID |
NPI | 1306831045 |
---|---|
Provider Name | Dr. Gregory John Kadlec |
First Address | Twin Falls, ID 83301-3366 |
Second Address | Twin Falls, ID 83301-3366 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 01/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002736200 | (05) | ID |
002736201 | (05) | ID |
002736202 | (05) | ID |
B63132 | (02) | ID |