Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 04-33089 | KS |
NPI | 1003011529 |
---|---|
Provider Name | John Christian Birky |
First Address | Garden City, KS 67846-5640 |
Second Address | Garden City, KS 67846-5614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 17/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200567860C | (05) | KS |