Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 2003028773 | MO |
NPI | 1114989183 |
---|---|
Provider Name | Jeffrey L Hackman |
First Address | Kansas City, MO 64108-2602 |
Second Address | Kansas City, MO 64108-2640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 17/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209201508 | (05) | MO |
I04992 | (02) | MO |