Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 0420010146 | VT |
N | 208800000X | Urologist | 26588 | IA |
NPI | 1023011517 |
---|---|
Provider Name | Eric Richmond Sargent |
First Address | Burlington, VT 05401 |
Second Address | Burlington, VT 05401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 19/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01786350 | (05) | NY |
0VN2503 | (05) | VT |
1023011517 | (05) | IA |
209143403 | (05) | MO |
37456 | BLUE CROSS BLUE SHIELD (01) | |
42143522520 | JOHN DEERE (01) | |
421435525 | TRI-CARE GROUP NUMBER (01) | |
71754 | WELLMARK/BLUE CROSS/BLUE (01) | IA |
F85682 | (02) | |
G87836 | CALIFORNIA LIC (01) | CA |