Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 01030934A | IN |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 01030934A | IN |
NPI | 1205839560 |
---|---|
Provider Name | Dr. Richard M. Sandefur JR. |
First Address | Newburgh, IN 47630-8954 |
Second Address | Newburgh, IN 47630-8954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 16/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100246580A | (05) | IN |
D95040 | (02) |