Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 036157894 | IL |
N | 208600000X | Surgeon | 036157894 | IL |
Y | 208200000X | Surgeon | 117216 | MO |
Y | 208600000X | Surgeon | 117216 | MO |
N | 208200000X | Surgeon | 30773 | KS |
N | 208600000X | Surgeon | 30773 | KS |
N | 2086S0102X | Surgical Critical Care | 036157894 | IL |
N | 2086S0127X | Trauma Surgeon | 036157894 | IL |
N | 2086S0127X | Trauma Surgeon | 117216 | MO |
NPI | 1306812029 |
---|---|
Provider Name | Dr. Roy R Danks |
First Address | Carbondale, IL 62902-3988 |
Second Address | Carbondale, IL 62901-1474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 14/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200262370J | (05) | KS |
H13596 | (02) | KS |