Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 310210 | LA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | R-10460 | IA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 04-43900 | KS |
NPI | 1013466598 |
---|---|
Provider Name | Jaya Prasad Shanmugam |
First Address | Pratt, KS 67124-2903 |
Second Address | Pratt, KS 67124-3092 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2016 |
Last Update Date | 06/04/2021 |