Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 4519 | IA |
Y | 213ER0200X | Radiology | 4519 | IA |
NPI | 1275661720 |
---|---|
Provider Name | Dr. Robin Richard Canterbury |
First Address | Davenport, IA 52803-5214 |
Second Address | Davenport, IA 52803-5214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0245928 | (05) | IA |
U55149 | (02) | IA |