Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2015027319 | MO |
N | 208600000X | Surgeon | 2015027319 | MO |
Y | 2086X0206X | Surgical Oncologist | 2015027319 | MO |
NPI | 1083670442 |
---|---|
Provider Name | Eric T Kimchi |
First Address | Columbia, MO 65212 |
Second Address | Columbia, MO 65212-8908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 22/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I39718 | (02) |