Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO04214 | |
N | 222Z00000X | Podiatrist | CPO04214 | |
Y | 224P00000X | Prosthetist | CPO04214 |
NPI | 1164197885 |
---|---|
Provider Name | Ian Burford |
First Address | Wichita, KS 67202-2044 |
Second Address | Wichita, KS 67218-1607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2021 |
Last Update Date | 13/08/2021 |