Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 60004 | KS |
NPI | 1851366926 |
---|---|
Provider Name | Dr. Harold D Wallin JR. |
First Address | Kansas City, KS 66112-1636 |
Second Address | Kansas City, KS 66112-1636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U82100 | (02) | KS |