Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 04-15120 | KS |
N | 207ND0101X | MOHS-Micrographic Surgeon | 04-15120 | KS |
N | 207ND0900X | Dermatopathologist | 04-15120 | KS |
N | 207NP0225X | Pediatric Dermatologist | 04-15120 | KS |
N | 207NS0135X | Procedural Dermatology | 04-15120 | KS |
NPI | 1154414951 |
---|---|
Provider Name | Dr. Robert D Durst JR. |
First Address | Topeka, KS 66604-1306 |
Second Address | Topeka, KS 66604-1306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 18/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000095 | BLUE CROSS BLUE SHIELD KS (01) | |
070005489 | RAILROAD MEDICARE (01) | KS |
D09098 | (02) |