Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 036129902 | IL |
N | 204F00000X | Transplant Surgeon | 43890 | AZ |
N | 208200000X | Surgeon | MD433479 | PA |
N | 208600000X | Surgeon | MD433479 | PA |
NPI | 1043439748 |
---|---|
Provider Name | Dr. John W Hsu |
First Address | Peoria, IL 61603-3089 |
Second Address | Peoria, IL 61603-3089 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 04/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102548086 | (05) | PA |
202466 | MEDICARE PTAN (01) | |
569040 | (05) | AZ |