Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 04-25172 | MO |
NPI | 1386608297 |
---|---|
Provider Name | Eugene Bortnick |
First Address | Overland Park, KS 66211-1630 |
Second Address | Overland Park, KS 66211-1630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C50814 | (02) |