Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 226294 | MA |
N | 208000000X | Pediatrician | G79591 | CA |
N | 2080P0204X | Pediatric Emergency Doctor | 226294 | MA |
Y | 2080P0204X | Pediatric Emergency Doctor | G79591 | CA |
NPI | 1164472536 |
---|---|
Provider Name | Dr. Robert I Mccaslin |
First Address | Jefferson City, MO 65101-2291 |
Second Address | Sacramento, CA 95817-1460 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 04/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2110415 | (05) | MA |
C79112 | (02) |