Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | M7772 | TX |
Y | 207X00000X | Orthopaedic Surgeon | MD2006-0847 | NM |
NPI | 1013914530 |
---|---|
Provider Name | Dr. Kenneth M Yaw |
First Address | Roswell, NM 88202-2344 |
Second Address | Roswell, NM 88201-5151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 08/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38602377 | (05) | NM |
D87499 | (02) | NM |