Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 4301091356 | MI |
Y | 207U00000X | Nuclear Medicine Specialist | E-5892 | AR |
N | 208D00000X | General Practice Physician | 4301091356 | MI |
NPI | 1134304512 |
---|---|
Provider Name | Dr. Jan Ryszkowski |
First Address | Little Rock, AR 72205-7101 |
Second Address | Little Rock, AR 72205-7101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2008 |
Last Update Date | 09/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
174688001 | (05) | AR |