Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 2016022749 | MO |
N | 208200000X | Surgeon | 2016022749 | MO |
N | 208600000X | Surgeon | 2016022749 | MO |
N | 208200000X | Surgeon | ME95769 | FL |
N | 208600000X | Surgeon | ME95769 | FL |
NPI | 1578517389 |
---|---|
Provider Name | Eddie R Island |
First Address | Kansas City, MO 64131-4517 |
Second Address | Kansas City, MO 64111-5941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 20/11/2018 |