Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 04-21083 | KS |
NPI | 1013949338 |
---|---|
Provider Name | Eustaquio O Abay II |
First Address | Wichita, KS 67218-1037 |
Second Address | Wichita, KS 67218-1037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 09/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100204380C | (05) | KS |
B91224 | (02) | |
B91224 | (02) | KS |