Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 05-26967 | KS |
NPI | 1003880725 |
---|---|
Provider Name | Dr. Jane Daugherty-Luck |
First Address | Hays, KS 67601-2370 |
Second Address | Hays, KS 67601-2370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 26/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100425560A | (05) | KS |
F26967 | (02) | KS |