Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2014006061 | MO |
N | 207Q00000X | Family Doctor | M1301 | TX |
N | 207Q00000X | Family Doctor | MD-42702 | IA |
N | 207QS0010X | Family Doctor - Sports Medicine | 036147144 | IL |
NPI | 1205909074 |
---|---|
Provider Name | Hans James Raj |
First Address | Quincy, IL 62301-4038 |
Second Address | Lewistown, MO 63452-2560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 14/01/2022 |