Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 01075345A | IN |
N | 207PP0204X | Pediatric Emergency Physician | 1117051A | IN |
NPI | 1649605007 |
---|---|
Provider Name | Jason Saunders |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianpolis, IN 46202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2013 |
Last Update Date | 04/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201185500 | (05) | IN |