Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 04-31302 | KS |
NPI | 1013987924 |
---|---|
Provider Name | Fadi Estephan |
First Address | Hutchinson, KS 67502-1131 |
Second Address | Hutchinson, KS 67502-1131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 19/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200326230 A | (05) | KS |
H56020 | (02) |