Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 04-22803 | KS |
NPI | 1306813571 |
---|---|
Provider Name | Dr. John W Fanning |
First Address | Wichita, KS 67226-8112 |
Second Address | Wichita, KS 67226-8112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 27/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100165590D | (05) | KS |
F60226 | (02) | KS |