Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071004843 | IL |
Y | 103TC0700X | Clinical Psychologist | 071004843 | IL |
NPI | 1003858572 |
---|---|
Provider Name | Dr. R Scott Furda |
First Address | Chicago, IL 60631-3745 |
Second Address | Chicago, IL 60631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 06/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01607654 | BLUE CROSS BLUE SHIELD (01) | IL |
300151523 | (02) |