Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 97-293 | NM |
NPI | 1003837469 |
---|---|
Provider Name | Dr. William Kinlaw |
First Address | Salem, OR 97308-2505 |
Second Address | Santa Fe, NM 87505-7601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 20/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000R6776 | (05) | NM |
14924 | PRESBY- TERIAN (01) | |
189016 | RIO PRIMARY CARE (01) | |
2513 | LOVELACE (01) | |
G63390 | (02) |